[1]张法尧△ 赵树森 谭红军.氨甲环酸滞留给药对全髋关节置换术后失血量的影响[J].中国中医骨伤科杂志,2017,25(04):31-34.
 ZHANG Fayao ZHAO Shusen TAN Hongjun.Effect of Tranexamic Acid Detained in the Wound on Blood Loss after Total Hip Arthroplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(04):31-34.
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氨甲环酸滞留给药对全髋关节置换术后失血量的影响()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年04期
页码:
31-34
栏目:
临床研究
出版日期:
2017-04-06

文章信息/Info

Title:
Effect of Tranexamic Acid Detained in the Wound on Blood Loss after Total Hip Arthroplasty
文章编号:
1005-0205(2017)04-0031-04
作者:
张法尧12△ 赵树森1 谭红军1
1.黑龙江齐齐哈尔市中医医院骨科(黑龙江 齐齐哈尔,161005)
2.中国中医科学院望京医院(在读博士)
△.通信作者:E-mail:jipinningmeng@126.com
Author(s):
ZHANG Fayao1 ZHAO Shusen1 TAN Hongjun1
1.Department of Orthopedics, Qiqihar Traditional Chinese Medicine Hospital, Qiqihar 161005, Heilongjiang China;
2.Wangjing Hospital of China Academy of Chinese Medical Science,Beijing 100102,China.
关键词:
氨甲环酸 滞留 全髋关节置换术 失血
Keywords:
tranexamic acid detain total hip arthroplasty blood loss
分类号:
R687.4
文献标志码:
A
摘要:
目的:研究人工全髋关节置换术中创口滞留氨甲环酸注射液对术后失血量的影响。方法:选取齐齐哈尔市中医医院2014年9月至2015年12月行老年股骨颈骨折患者初次人工全髋关节置换术患者60例,其中治疗组(TXA)30例术中创口滞留使用氨甲环酸注射液20 mg/kg,对照组30例术中滞留生理氯化钠注射液,对比两组术后总失血量、术中出血量、术后引流血量、隐性失血量、凝血酶原时间(PT)、活化部分凝血酶时间(APTT),凝血酶时间(TT),术后14 d 内下肢静脉血栓发生、创口渗血和瘀斑等指标。结果:两组患者术中出血量、隐性失血量差异无统计学意义(P>0.05),总失血量、术后引流血量,TXA组明显少于对照组,差异有统计学意义(P<0.05); 术后 PT,APTT,TT 比较差异均无统计学意义(P>0.05),超声检查所有患者均无下肢深静脉血栓(DVT)形成,无肺栓塞(PE)的发生,而TXA组创口渗血及瘀斑形成明显少于对照组。结论:氨甲环酸注射液术中创口内滞留给药能有效减少老年股骨颈骨折患者初次人工全髋关节置换术后失血量、创口渗血及周围瘀斑的发生,并不增加血栓形成风险。
Abstract:
Objective:To study curative effect on blood loss of elderly patients with femoral neck fracture by tranexamic acid detained in the wound during total hip arthroplasty(THA). Methods:Sixty eldly patients who received primary unilateral THA from September 2014 to December 2015 were enrolled. Among them, 30 cases were in the tranexamic acid group, 30 cases with-out use of tranexamic acid were as control. In tranexamic acid group, 20 mg /kg of tranexamic acid was infused in the wound, and patients in control group were not. Total blood loss, postoperative drainage, hidden blood loss, prothrombin time(PT)and activated partial thromboplastin time(APTT)were recorded and compared between the two groups. Complications were analyzed when postoperative 14 d( the lower limb venous thrombosis was checked by ultrasound).Results:There were significant differences between two groups about total blood loss, postoperative drainage(P<0.05).There was no significant difference between two groups about hidden blood loss, PT and APTT(P>0.05). Deep vein thrombosis was not found by ultrasound after operation. Conclusion:The use of tranexamic acid can significantly decrease postoperative blood loss, errhysis and ecchymosis around the wound without increasing the risk of thrombosis in patients with THA.

参考文献/References:

[1] Gillette BP,Desimone LJ,Trousdale RT,et al.Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty[J].Clin Orthop Relat Res,2013,471(1):150-154.
[2] Imai N,Dohmae Y,Suda K,et al.Tranexamic acid for reduction of blood loss during total hip arthroplasty[J].J Arthroplasty,2012,27(10):1838-1843.
[3] Kazemi SM,Mosaffa F,Eajazi A,et al.The effect of tranexamic acid on reducing blood loss in cementless total hip arthroplasty under epidural anesthesia[J].Orthopedics,2010,33(1):17-22.
[4] 谢锦伟,岳辰,裴福兴.氨甲环酸在全髋关节置换术中的有效性与安全性研究进展[J].中国矫形外科杂志,2014,22(20):1856-1860.
[5] Naler SB,Hidalgo JU,Bloch T.Prediction of blood volume in normal human adults[J].Surgery,1962,51(2):224-232.
[6] Gross JB.Estimating allowable blood loss:corrected for dilution[J].Anesthesiology,1983,58(3):277-280.
[7] 王浩洋,康鹏德,裴福兴,等.氨甲环酸减少全髋关节置换术围手术期失血的有效性及安全性研究[J].中国骨与关节杂志,2015,4(8):649-654.
[8] Blanie A,Bellamy L,Rhayem Y,et al.Duration of postoperative fibrinolysis after total hip or knee replacement:a laboratory follow-up study[J].Thromb Res,2013,131(1):6-11.
[9] de Jonge T. Pharmacological reduction of bleeding during hip endoprosthetic replacement[J]. Orv Hetil,2012,153(41):1607-1612.
[10] Liu X,Zhang X,Chen Y,et al.Hidden blood loss after total hip arthroplasty[J].J Arthroplasty,2011,26(7):1100-1105.
[11] Hoylaerts M,Lijnen HR,Collen D.Studies on the mechanism of antifibrinolytic action of tranexamic acid[J].Biochim Biophys Acta,1981,673(1):75-85.
[12] Wong J,Abrishami A,EL Beheiry H,et al.Topical application of tranexamic acid reduces postoperative blood loose in total knee arthro-plasty:a randomized,controlled tril[J].J Bone Joint Surg Am,2010,92(15):2503-2513.
[13] 董锋,严实,禄代锋,等.氨甲环酸对老年股骨颈骨折行全髋关节置换术围手术期失血的疗效分析[J].哈尔滨医科大学学报,2015,49(4):331-334.
[14] Singh J,Ballal MS,Mitchell P,et al.Effects of tranexamic acid on blood loss during total hip arthroplasty[J].J Orthop Surg(Hong Kong),2010,18(3):282-286.
[15] 岳辰,周宗科,裴福兴,等.中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识[J].中华骨与关节外科杂志,2015,8(4):281-285.
[16] 华政哲,张敬东,韩文峰,等.氨甲环酸止血对全髋关节置换术围手术期失血量影响[J].临床军医杂志,2015,43(11):785-787.
[17] Yamasaki S,Masuhara K,Fuji T.Tranexamic acid reducesblood loss after cementless total hip arthroplasty-prospective randomized study in 40 cases[J].Int Orthop,2004,28(2):69-73.
[18] 岳辰,谢锦伟,蔡东峰,等.静脉联合局部应用氨甲环酸减少初次全髋关节置换术围手术期失血的有效性及安全性研究[J].中华骨与关节外科杂志,2015,8(1):44-48.
[19] Sattar S,Mason J,Sarda P,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total hip replacement:a randomized controlled trial(TRANX-H)[J].J Bone Joint Surg Am,2013,95(21):1969-1974.

更新日期/Last Update: 2017-04-07