氨甲环酸注射液对全膝关节置换围手术期失血量影响的探讨

目的探讨氨甲环酸注射液对全膝关节置换围手术期失血量的影响。方法选取2015 年3 月-2016 年8 月于该院收治的147 例初次实施单侧全膝关节置换的类风湿关节炎或骨性关节炎患者，按照随机数字表法将所有患者随机分为单次使用组和重复使用组以及对照组3组，每组患者49 例，所有患者均在术前半小时和间隔12 h 后使用头孢呋辛1.5 g以预防出现感染，对于对头孢呋辛过敏的患者则在术前2 h给予克林霉素治疗。所有患者手术均在止血带下完成，麻醉方式均为神经阻滞联合全身麻醉的方式，在手术完成时缝合伤口并运用弹力绷带加压包扎。单次使用组患者在术前半小时给予10 mg/kg 的氨甲环酸进行静脉滴注，而重复使用组则分别在术前半小时给予10 mg/kg 的氨甲环酸进行静脉滴注，安装好假体后在患者假体周围再次注射50 ml 氨甲环酸注射液，而对照组患者则在手术前后不再使用氨甲环酸注射液。患者住院期间应选择低分子肝素进行药物预防，出院后则口服10 mg 的利伐沙班至术后2周左右，每天服用1次。分析比较3 组患者的隐形失血量和总失血量以及术中失血量、引流量、输血患者比例、肺栓塞和深静脉血栓的发生等指标。结果重复使用组患者的术后引流量、术中失血量、隐形失血量和术后总失血量等均低于单次使用组患者，而单次使用组患者的术后引流量、术中失血量、隐形失血量和术后总失血量等则低于对照组患者（P <0.05）；单次使用组和重复使用组患者的输血患者比例均低于对照组（χ2=3.984 和5.482，P <0.05），而单次使用组的输血患者比例则高于重复使用组（χ2=8.182，P <0.05）。各组患者术后均无肺栓塞和深静脉血栓等并发症出现，单次使用组有4 例患者出现肌间静脉血栓，而重复使用组和对照组则各有3 例患者出现肌间静脉血栓，各组患者并发症发生率差异无统计学意义（χ2=0.173，P >0.05）。结论氨甲环酸注射液能够在不增加肺栓塞和深静脉血栓发生率的同时，有效降低全膝关节置换术中患者的出血量，减少患者的输血比例和输血量，值得在临床上加以推广使用。

Effect of Tranexamic Acid injection on blood loss during the perioperative period of total knee arthroplasty

Objective To investigate the effect of Tranexamic Acid injection on blood loss during the perioperative period of total knee arthroplasty. Methods A total of 147 cases undergoing primary unilateraltotal knee arthroplasty with rheumatoid arthritis or osteoarthritis were selected from March 2015 to August 2015. According to random number table, all of the patients were randomly divided into single use group,repeated use group and control group, with 49 cases in each group. The single use group was given tranexamic acid 10 mg/kg by intravenous drip half an hour before surgery, the repeated use group was given the same one half an hour before surgery and Tranexamic Acid 50 ml by intramuscular injection in periprosthetic tissue after surgery. The control group was not given tranexamic acid injection. Hidden blood loss, total blood loss, intraoperative blood loss, volume of postoperative drainage, the ratio of blood transfusion,the incidence of pulmonary embolism and the incidence of deep vein thrombosis were compared among the three groups. Results The volume of postoperative drainage, the intraoperative blood loss, the hidden blood loss and the postoperative total blood loss in the single use group were significantly lower than those in the control group, but significantly higher than those in the repeated use group (P < 0.05); the ratio of blood transfusion in the single use group and the repeated use group was significantly lower than that in the control group (x2= 3.984 and 5.482,p < 0.05), but was significantly higher than that in the repeated use group (x2=8.182, p< 0.05). No pulmonary embolism or deep vein thrombosis was occurred in each group. Muscular venous thrombosis was found 4 cases in the single use group and 3 cases in the repeated use group and thecontrol group, but there was no significant difference among the three groups (x2 = 0.173, p> 0.05). Conclusions Tranexamic Acid injection can reduce the amount of bleeding and the ratio of blood transfusion in patients with total knee arthroplasty, but will not increase the incidence of pulmonary embolism or deep vein thrombosis.