氨甲环酸围手术期小剂量给药对非骨水泥全髋关节置换术患者失血量影响的临床观察

目的探讨小剂量氨甲环酸注射液对非骨水泥全髋关节置换术(THA)患者失血量的临床效果。方法本研究以2014年1月~2015年12月深圳市龙华新区人民医院收治的行单侧非骨水泥THA的患者62例为研究对象。根据患者就诊顺序并结合随机数字表法,将受试者随机分为观察组(n=31)与对照组(n=31)。观察组在术前及术后分别给予氨甲环酸注射剂10mg/kg,对照组仅给予0.9%氯化钠注射液。研究者比较两组患者术中的出血量、术后3d内的出血量、绝对失血量、隐性失血量以及术后第3天的血红蛋白(Hb)、红细胞比积(Hct)、血小板计数(PLT)、出血时间及活化的部分凝血酶原时间(APTT)。结果观察组术中的出血量、术后3d内的出血量、手术隐性失血量及手术绝对失血量分别为(297.64±65.52)g、(179.45±40.47)g、(136.83±46.49)g、(625.26±106.08)g,均显著低于对照组的(357.55±65.41)g、(221.47±47.30)g、(194.26±33.10)g、(714.75±89.72)g(P0.05);术后第3天,观察组的血红蛋白浓度及红细胞比容分别为(92.54±12.66)g/L和(0.26±0.01)%,显著高于对照组的(82.26±11.57)g/L和(0.23±0.02)%(P0.05);两组术后的平均住院时间分别为(16.48±3.23)d,和(15.84±2.91)d,均未发现明显并发症的发生(P0.05)。结论氨甲环酸注射剂围手术期小剂量给药可显著减少非骨水泥THA后患者的失血量且不增加血栓栓塞等并发症的发生率。

Effect of small doses of tranexamic acid on blood loss in perioperative period in cementless total hip arthroplasty patients

Objective To investigate the clinical effect of small dose of tranexamic acid injection for cementless total hip arthroplasty in patients with blood loss.Methods In this study,62 unilateral bone cement THA patients from Jan.2014 to Dec.2015 in Longhua District People`s Hospital were as the research objects.The patients were divided into the observation group (n=31) and the control group (n=31),according to the order of the patients and the random number table method.The observation group was given tranexamic acid injection 10mg/kg,and the control group only received 0.9% sodium chloride injection.The intraoperative bleeding,postoperative bleeding,absolute blood loss,the hidden blood loss and hemoglobin,hematocrit,platelet counts,bleeding time and activated partial thromboplastin time on the postoperative third day between the two groups were compared.Results The intraoperative bleeding,the amount of bleeding,hidden blood loss,surgical absolute blood loss at the postoperative 3 d of the observation group were (297.64±65.52)g,(179.45±40.47)g,(136.83±46.49)g,(625.26±106.08)g,respectively,significantly lower than those in the control group (357.55±65.41)g,(221.47±47.30)g,(194.26±33.10)g,(714.75±89.72)g (P<0.05).On the third day after operation,the hemoglobin concentration and hematocrit in the observation group were (92.54±12.66)g/L and (0.26±0.01)%,significantly higher than those in the control group of (82.26±11.57)g/L and (0.23±0.02)% (P<0.05).The average length of hospital stay in the two groups was (16.48±3.23)d and (15.84±2.91)d,and no significant complication occurred after surgery (P>0.05).Conclusion Small doses of tranexamic acid injection during perioperative period can significantly reduce blood loss in patients without bone cement after THA,and do not increase the incidence of thromboembolic complications.