氨甲环酸减少初次非骨水泥全髋置换围术期失血有效性及安全性研究

背景：全髋关节置换术是治疗髋关节终末期疾病的有效手段,但其常伴随显著的失血且需要输血,人工合成抗纤溶药氨甲环酸在全髋关节置换术围手术期血液管理中正扮演着越来越重要的角色。目的：探讨术前静脉单剂量使用氨甲环酸减少初次单侧非骨水泥全髋关节置换术围术期失血的有效性及安全性。方法方法：回顾分析2012年9月至2013年3月行初次单侧非骨水泥全髋关节置换术前未使用氨甲环酸患者291例（对照组）和2013年4月至9月术前静脉单剂量使用15 mg/kg氨甲环酸患者220例（氨甲环酸组）的临床资料。比较两组术前及术后第1、3天血红蛋白,血细胞比容,住院时间,失血量,输血及血栓事件发生率。结果：氨甲环酸组围术期平均总失血量和输血率显著低于对照组（973.30±355.65）ml vs（1275.20±453.75）ml,5.45%vs 20.62%,P〈0.001]。氨甲环酸组和对照组术后肌间静脉血栓发生率分别为5.00%和5.15%（P=0.937）。氨甲环酸组中1例（0.45%）发生深静脉血栓,对照组2例（0.69%）,两组比较差异无统计学意义。无1例出现肺栓塞。术后第1天、第3天氨甲环酸组的血红蛋白及血细胞比容均显著高于对照组（P〈0.001）。结论：术前静脉滴注15 mg/kg氨甲环酸可安全、有效地减少初次单侧非骨水泥全髋关节置换术围术期的失血及输血。

A retrospective study on the efficacy and safety of tranexamic acid for reducing perioperative bleeding during primary cementless total hip arthroplasty

Background： Total hip arthroplasty（THA） is an effective way to treat end- staged disease of hip. But there is significant blood loss in the procedure and transfusion is oftern essential. Tranexamic acid（TXA）, a synthetic antifibrinolysis agent,plays a more and more important role in the perioperative blood management of THA.Objective： To explore the efficacy and safety of preoperative administration of intravenous single bolus of 15 mg TXA in reducing perioperative bleeding and blood transfusion in primary unilateral cementless THA.Methods： A retrospective study were done in 291 patients who underwent primary unilateral cementless THA without TXA from September 2012 to March 2013（control group） and in 220 patients with THA and TXA from April 2013 to September2013（TXA group）. Hematoglobin and hematocrit before THA and on Day 1 and Day 3 after THA, hospital stay, blood loss,and the incidences of transfusion and thromboembolic events were compared between groups.Results： The total blood loss and incidence of blood transfusion in TXA group were significantly lower than those in control group（973.30±355.65]ml vs 1275.20±453.75]ml, 5.45% vs 20.62%, P〈0.001）. The incidence of thromboembolic events was 5.00% in TXA group and 5.15% in control group, P=0.937）. Deep vein thrombosis occurred in one case（0.45%） in TXA group and in 2 cases（0.69%） in control group（P=1.000）. No symptomatic pulmonary embolism occurred in each group. The levels of hematoglobin and hematocrit on Day 1 and Day 3 after THA in TXA group were significantly higher than those in control group（P〈0.001）.Conclusions： Preoperative intravenous single dose of 15 mg TXA is safe and effective on reducing blood loss and transfusion requirement in primary unilateral cementless THA.