氨甲环酸在全髋关节置换术中的止血效果及安全性分析

发布时间：2018-03-28 02:03

本文选题：氨甲环酸　切入点：髋　出处：《浙江大学》2015年硕士论文

【摘要】：目的比较氨甲环酸(tranexamic acid, TXA)的不同用法在减少单侧初次全髋关节置换术(total hip arthroplasty, THA)术后出血的疗效及安全性。方法回顾性分析2014年1月至2015年2月符合入选要求的97例行单侧初次全髋关节置换术的患者资料。其中男52例,女45例,根据术中氨甲环酸的使用方法不同分为三组。A组35例：不用氨甲环酸；B组32例：缝合关节腔后给予关节腔内注射30mg/kg的氨甲环酸；C组30例：切皮前予15mg/kg的氨甲环酸静脉滴注,缝合关节腔后给予关节腔内注射3Omg/kg的氨甲环酸。统计各组患者的性别,年龄,体重指数(body mass index, BMI),术前血红蛋白(hemoglobin, Hb),红细胞压积(hematocrit, HCT)以及术中失血量、术后48h引流量、输血率、术后血红蛋白、红细胞压积及手术前后血红蛋白、红细胞压积差值等评价指标,并观察患者术后是否出现下肢深静脉血栓形成(deep venous thrombosis, DVT)及肺栓塞(pulmonary embolism, P E)的临床症状,并针对性地进行下肢血管多普勒超声及肺动脉血管成像(computed tomography angiography, CTA)检查。结果术前三组患者性别,年龄,体重指数,术前血红蛋白,红细胞压积指标比较差异无统计学意义(P/χ2＞0.05),术中失血量、术后DVT/P E及肺炎、切口感染等并发症发生率三组比较差异无统计学意义(P/χ2＞0.05),但术后48h引流量、输血率A组大于B组和C组(P0.05),B组和C组在输血率、术后Hb及HCT方面无明显差异(P0.05),但是值得注意的是手术前后血红蛋白和红细胞压积下降幅度B组大于C组(P0.05)。结论局部应用氨甲环酸能明显降低全髋关节置换术患者的术后失血量及输血率,局部联合静脉应用止血效果更好,并且不增加静脉血栓形成的风险。
[Abstract]:Purpose. To compare the efficacy and safety of different use of tranexamic acid (TXA) in reducing bleeding after unilateral total hip arthroplasty (tha). Method. The data of 97 patients undergoing unilateral primary total hip arthroplasty from January 2014 to February 2015 were analyzed retrospectively, including 52 males and 45 females. According to the different methods used in operation, the patients were divided into three groups: group A (n = 35): group B (n = 32), group B (n = 32): group C (n = 30) treated with intraarticular injection of 30mg/kg after suture of articular cavity, and group C (n = 30) received 15mg/kg intravenously before skin incision. Patients in each group were given intraarticular injection of 3Omg/kg after suture. Sex, age, body mass index (BMI), body mass index (BMI), preoperative hemoglobin hemoglobulin (HB), hematocrit (HCT), hematocrit (HCT), blood loss during operation, drainage flow at 48 hours after operation, and blood transfusion rate were counted. Hemoglobin, hematocrit, difference of hemoglobin and hematocrit before and after operation were evaluated. The clinical symptoms of deep venous thrombus (DVTs) and pulmonary embolism (Pe) were observed. The lower extremity vascular Doppler ultrasound and pulmonary artery angiography were performed by computed tomography angiography (CTA). There was no significant difference in sex, age, body mass index, preoperative hemoglobin and hematocrit in the three groups before operation (P / 蠂 2 > 0.05). Blood loss, postoperative DVT/P E and pneumonia were not significant in the three groups. There was no significant difference in the incidence of incision infection and other complications among the three groups, but the blood transfusion rate in group A was higher than that in group B and group C at 48 h after operation, and the blood transfusion rate in group A was higher than that in group B and group C. There was no significant difference in HB and HCT, but it was worth noting that the decrease of hemoglobin and hematocrit before and after operation in group B was greater than that in group C (P 0.05). Conclusion. The blood loss and blood transfusion rate of total hip arthroplasty patients were significantly decreased by local application of carbamoic acid, and the hemostatic effect of local combined intravenous application was better, and the risk of venous thrombosis was not increased.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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