氨甲环酸序贯利伐沙班在全髋关节置换术中的效果评价

发布时间：2018-03-06 20:31

本文选题：氨甲环酸　切入点：全髋关节置换术　出处：《重庆医学》2017年16期 　论文类型：期刊论文

【摘要】：目的探索氨甲环酸(TXA)序贯利伐沙班在全髋关节置换术(THA)围术期减少出血及预防血栓的疗效。方法筛选从2012-2015年在广西壮族自治区人民医院拟行初次一侧THA的患者,共150例,用随机对照的实验方法将患者分为5组,分别命名为A、B、C、D、E组,每组患者各30例。A组患者作为空白组,不应用药物干预;B组在手术前应用10mg/kg TXA溶于100mL生理盐水静脉滴注;C组在手术前应用15mg/kg TXA溶于100mL生理盐水静脉滴注;D组在手术前及3h后分别应用15mg/kg TXA溶于100mL生理盐水静脉滴注;E组在手术前应用15 mg/kg TXA静脉滴注,关闭切口时再局部应用1g TXA。术后6~12h视引流量予以抗凝,一般在引流量小于30mL/h口服利伐沙班10mg,按常规剂量抗凝至术后35d。统计5组患者术中失血量、术后引流量、隐性失血量、输血人数和输血率、术后开始抗凝及拔除引流管时间、术后第1天凝血酶原和部分活化凝血活酶时间、血红蛋白下降值及深静脉血栓(DVT)和肺栓塞(PE)的发生率。结果术中失血量、术后引流量、隐性失血量、输血人数和输血率、术后第1天血红蛋白下降值在5组患者之间比较差异有统计学意义(P0.05);而D组患者术中出血量、术后引流量、隐性失血量、输血率、术后第1天Hb下降值、术后开始抗凝时间、术后拔除引流管时间与A组各项指标比较,差异有统计学意义(P0.05)。所有患者在围术期及术后3个月内随访均未发生症状性DVT及PE。结论 THA应用TXA序贯利伐沙班是安全、有效的,且术前及3h后各应用15mg/kg TXA对减少THA失血量的效果最显著。
[Abstract]:Objective to explore the efficacy of sequential Levashaban in reducing bleeding and preventing thrombosis during total hip arthroplasty (THA). Methods one hundred and fifty patients with primary unilateral THA were selected from 2012 to 2015 in Guangxi Zhuang Autonomous region people's Hospital. The patients were divided into 5 groups by randomized control method. Each group was divided into 5 groups, 30 patients in each group, 30 patients in group A, and 30 patients in group A as blank group. No drug intervention: 10 mg / kg TXA dissolved in 100ml saline intravenously before operation in group C 15mg / kg TXA dissolved in 100ml saline solution before operation and 15mg / kg TXA dissolved in 100ml physiological salt in group D before and 3 hours after operation. Group E was treated with 15 mg/kg TXA before operation. Local application of 1g TXA.The anticoagulant effect was performed at 6h and 12h after operation. In general, 10 mg of rivastaban was given orally for less than 30 mL / h after operation. The volume of blood loss during operation, drainage flow after operation, and hidden blood loss were counted in 5 groups according to the routine dose of anticoagulant to 35 days after operation. The number of blood transfusions and the rate of blood transfusion, the time of anticoagulant and extubation, the time of prothrombin and partial activated thromboplastin on the first day after operation, the decrease of hemoglobin, the incidence of DVT and PE2) were analyzed. There were significant differences in postoperative drainage volume, recessive blood loss, blood transfusion number, blood transfusion rate and hemoglobin drop value among the five groups on the first day after operation (P 0.05), while in group D, intraoperative bleeding volume, postoperative drainage volume, recessive blood loss were significantly higher than those in the control group (P < 0.05). The blood transfusion rate, the decrease of HB on the first day after operation, the anticoagulant time after operation, the time of pulling out the drainage tube after operation were compared with the indexes of group A. The difference was statistically significant (P 0.05). No symptomatic DVT and Pe were found in all patients during perioperative period and 3 months after operation. Conclusion it is safe and effective to use TXA sequential Levashaban in THA. The effect of 15 mg / kg TXA before and after 3 hours on reducing the blood loss of THA was the most significant.
【作者单位】：广西医科大学;广西壮族自治区人民医院骨科;武汉大学;
【基金】：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z2016597)
【分类号】：R687.4

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