[1]郑志辉△,李晓武,关可立,等.氨甲环酸不同给药方式对单膝关节置换术失血量的影响[J].中国中医骨伤科杂志,2017,25(05):41-44.
　ZHENG Zhihui LI Xiaowu GUAN Keli ZHENG Xun CHEN Haibo ZENG Qingqiang.The Efficacy and Safety of Different Administration of Tranexamic Acid to Reduce Blood Loss in Primary Unilateral Total Knee Arthroplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(05):41-44.
点击复制

氨甲环酸不同给药方式对单膝关节置换术失血量的影响()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年05期
页码:
41-44
栏目:
临床研究
出版日期:
2017-05-08

文章信息/Info

Title:
The Efficacy and Safety of Different Administration of Tranexamic Acid to Reduce Blood Loss in Primary Unilateral Total Knee Arthroplasty
文章编号:
1005-0205(2017)05-0041-04
作者:
郑志辉1△;  李晓武1;  关可立1;  郑洵1;  陈海波1;  曾庆强1
1.广东汕头市中医医院(广东 汕头,515031)
△.通信作者 E-mail:89000231@qq.com
Author(s):
ZHENG Zhihui1△ LI Xiaowu1 GUAN Keli1 ZHENG Xun1 CHEN Haibo1 ZENG Qingqiang1
1.Shantou Hospital of Traditional Chinese Medicine,Shantou 515031,Guangdong China.
关键词:
氨甲环酸;  全膝关节置换术;  关节腔内注射;  静脉滴注;  失血量
Keywords:
tranexamic acid;  total knee arthroplasty(TKA);  intra-articular injection;  intravenous drip;  blood loss
分类号:
R687.4
文献标志码:
A
摘要:
目的:探讨围手术期静脉联合局部应用氨甲环酸对减少初次单侧人工全膝关节置换术(TKA)失血量的有效性及安全性。方法:将2013年1月至2015年7月于我院行单侧TKA术的90例患者随机分为三组:A组(联合给药组)、B组(静脉给药组)及C组(腔内注射组),每组30例。三组患者年龄、性别、体质量指数(BMI值)、术前血红蛋白(Hb),HCT,PT,APTT,INR,手术时间及术中使用止血带时间差异均无统计学意义(P>0.05)。比较三组患者显性出血量、隐性失血量、总失血量、PT,APTT,INR,有否输血及并发症深静脉血栓(DVT)发生情况。结果:术后总失血量A组低于B组及C组,差异均有统计学意义(P<0.01); C组小于B组,差异有统计学意义(P<0.05)。术后PT,APTT,INR对比,三组差异无统计学意义,与术前对比差异亦无统计学意义。三组患者术后均未发现DVT.输血率A组低于B组,差异有统计学意义(P<0.05); 而A组与C组、B组与C组对比差异无统计学意义。结论:术前静滴联合术中关节腔内注射氨甲环酸能明显减少初次单侧TKA术后失血量、降低术后输血率,且不增加术后DVT发生率; 另外,单独关节腔内注射在控制TKA围手术期失血量方面效果优于单独静脉使用氨甲环酸。
Abstract:
Objective:To explore the efficacy and safety of preoperative intravenous drip infusion and intraoperative intra-articular injection of tranexamic acid for reducing blood loss in primary unilateral total knee arthroplasty(TKA)in the perioperative period.Methods:Totally 90 cases underwent primary unilateral TKA admitted from January 2013 to July 2015 were randomly divided into group A(combined administration),group B(intravenous drip administration)and group C(intracavitary administration),30 patients in each group.The patients in three groups have no statistical difference on age,sex,body mass index(BMI),preoperative hemoglobin(Hb),HCT,PT,APTT,INR,operation time and tourniquet time(P>0.05).Compare the dominant blood loss,hidden blood loss,total blood loss,PT,APTT,INR,the number of blood transfusion and the incidence of deep venous thrombosis(DVT)among 3 groups.Results:The total blood loss of group A was less than the group B and group C,the difference was statistically significant(P<0.01),and group C was less than group B with the statistically significant difference(P<0.05).The difference among the three groups in PT,APTT,INR after surgery was not statistically,and there was no statistical difference between the preoperative and postoperative.DVT were not found after surgery in all patients of three groups.As for blood transfusion rate,group A was lower than group B,the difference was statistically significant(P<0.05),while the difference of group A and group C,group B and group C had no significant difference.Conclusion:Combination of preoperative intravenous drip infusion with intraoperative intra-articular injection of tranexamic acid can effectively reduce blood loss and the rate of blood transfusion of primary unilateral TKA without increasing the risk of DVT.In addition,intraoperative intra-articular injection of tranexamic acid works better in controlling perioperative blood loss of TKA than intravenous tranexamic acid.

参考文献/References:

[1] Craik JD,Ei Shafie SA,Kidd AG,et al.Can local administration of tranexamic acid during total knee arthroplasty reduce blood loss and transfusion requirements in the absence of surgical drains [J].Eur J Orthop Surg Traumatol,2014,24(3):379-384.
[2] Alshryda S,Mason J,Vaghela M,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total knee replacement:a randomized controlled trial(TRANX-K)[J].J Bone Joint Surg Am,2013,95(21):1961-1968.
[3] Yamaguchi S,Ohno G,Kitamura J.Evaluation of perioperative blood loss and transfusion in total knee arthroplasty[J].Masui,2014,63(9):1029-1033.
[4] Ma J,Huang Z,Shen B,et al.Blood management of staged bilateral total knee arthroplasty in a single hospitalization period[J].J Orthop Surg Res,2014,9(1):116.
[5] 马金辉,孙伟,高福强,等.关节腔注射氨甲环酸单侧全膝关节置换者的失血量及肢体周径变化:随机对照[J].中国组织工程研究,2014,18(35):5577-5582.
[6] 柴喜平,柳海平,王承祥,等.关节腔注射氨甲环酸对初次单侧全膝关节置换术后失血量的影响[J].中国中医骨伤科杂志,2016,24(4):34-40.
[7] 胡旭栋,周宗科,裴福兴,等.全膝关节置换围手术期氨甲环酸不同使用方法的有效性和安全性[J].中华骨科杂志,2014,34(6):599-604.
[8] Nadler SB,Hidalgo JH,Bloch T.Prediction of blood volume in normal human adults[J].Surgery,1962,51(2):224-232.
[9] 胡旭栋,裴福兴,沈彬,等.不同剂量氨甲环酸减少全膝关节置换围手术期失血量的有效性[J].中国矫形外科杂志,2014,22(21):1943-1946.
[10] 张延杰,郝军,高文香,等.不同剂量氨甲环酸对全膝关节置换术后失血量的影响[J].山东医药,2013,53(19):53-55.
[11] 张福江,高志国,于建华.氨甲环酸减少全膝关节置换术出血量的临床对比研究[J].中国修复重建外科杂志,2007,12(21):1302-1304.
[12] 及松洁,周一新,李玉军,等.不同氨甲环酸给药途径对全膝关节置换术出血量影响的临床研究[J].重庆医学,2015,44(31):4367-4372.
[13] 石永进,王全彬,邱庆虎.氨甲环酸不同途径用药对全膝关节置换术失血量的影响[J].中国中西医结合外科杂志,2016,22(2):135-138.
[14] 王庆东,李付彬,徐向峰,等.氨甲环酸术前静脉滴注联合术中关节内注射对全膝关节置换术围手术期失血量的影响[J].中医正骨,2016,28(1):24-27.
[15] Hegde C,Wasnik S,Kulkarni S,et al.Simultaneous bilateral computer assisted total knee arthroplasty:the effect of intravenous or intraartic-ular tranexamic acid[J].J Arthroplasty,2013,28(10):1888-1891.
[16] Zhang Y,Fu X,Liu WX,et al.Safety and efficacy of intra-articular injection of tranexamic acid in total knee arthroplasty[J].Orthopedics,2014,37(9):775-782.
[17] Duncan CM,Gillette BP,Jacob AK,et al.Venous thromboembolism and mortality associated with tranexamic acid use during total hip and knee arthroplasty[J].J Arthroplasty,2015,30(2):272-276.
[18] Yang ZG,Chen WP,Wu LD.Efficacy and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis[J].J Bone Joint Surg Am,2012,94(13):1153-1159.

更新日期/Last Update: 2017-05-01