氨甲环酸在初次单侧全膝关节置换术围手术期应用的有效性及安全性研究

发布时间：2018-04-05 16:30

本文选题：氨甲环酸　切入点：TKA　出处：《广西医科大学》2017年硕士论文

【摘要】：目的:通过对初次单侧全膝关节表面置换术(TKA)围手术期应用氨甲环酸(TXA)的研究,明确静脉联合局部运用氨甲环酸在能够有效减少围手术期失血量,同时不增加深静脉血栓(DVT)和肺栓塞(PE)及严重出血事件的发生率。方法:通过前瞻性研究选择符合条件的初次单侧TKA病人60例,实验组30例,对照组30例。实验组静脉联合局部运用氨甲环酸,对照组用生理盐水局部对照,两组术后均按指南进行规范的抗凝治疗,比较两组患者在失血量、引流量及深静脉血栓(DVT)、肺栓塞(PE)及严重出血事件的发生率。结果:在失血量的比较方面,两组在术中失血量差异无统计学意义(P=0.164),在术后引流量及总失血量方面均少于对照组(P =0.000,P=0.000),差异均有统计学意义。两组患者在术后输血率差异有统计学意义(P=0.005)。在术后Hb下降幅度方面,术后第1天实验组Hb下降幅度较对照组术后第1天小,差异有统计学意义(P=0.028);但是在术后第3天、第5天实验组和对照组Hb下降幅度的差异无统计学意义(P=0.846, P=0.097)。两组患者在术后2周、术后1月均未发现肺栓塞、下肢深静脉血栓;但实验组在术后3月复查双下肢静脉彩超时发现2例出现肌间静脉血栓,对照组在术后3月发现1例出现肌间静脉血栓;两组患者术后均未发现严重出血事件。结论:在初次单侧全膝关节置换术围手术期中静脉联合局部应用氨甲环酸,既能有效控制术后失血量、减少输血率,同时也不增加术后血栓的发生风险。
[Abstract]:Objective: to study the effect of intravenously combined local use of tranexamic acid (TXA) on the perioperative blood loss in patients with primary unilateral total knee arthroplasty (TKAA).At the same time, the incidence of DVT and PE) and severe bleeding events were not increased.Methods: 60 patients with primary unilateral TKA, 30 patients in experimental group and 30 patients in control group were selected by prospective study.The experimental group was given intravenously combined with local administration of carbamate, while the control group was locally controlled by normal saline. The two groups were treated with standard anticoagulant therapy according to the guidelines after operation, and the blood loss was compared between the two groups.Incidence of drainage, DVT, PE and severe bleeding events.Results: there was no significant difference in the amount of blood loss between the two groups (P < 0. 164), but there was no significant difference between the two groups in terms of postoperative drainage volume and total blood loss, which were significantly lower than those in the control group (P < 0. 000).The difference of blood transfusion rate between the two groups was statistically significant.The decrease of HB in the experimental group on the first day after operation was smaller than that in the control group on the first day after operation, and the difference was statistically significant (P < 0.05), but on the third day after operation, the decrease of HB in the experimental group was significantly lower than that in the control group.On the 5th day, there was no significant difference in the decrease of HB between the experimental group and the control group (P 0. 846, P 0. 097).Pulmonary embolism and deep vein thrombosis of lower extremity were not found in both groups 2 weeks after operation and 1 month after operation, but 2 cases of intramuscular venous thrombosis were found in the experimental group 3 months after operation.In the control group, one patient was found to have intramuscular venous thrombosis at 3 months after operation, and no severe bleeding events were found in both groups.Conclusion: combined with local application of carbamoic acid in the perioperative period of primary unilateral total knee arthroplasty can not only effectively control postoperative blood loss and reduce blood transfusion rate, but also do not increase the risk of postoperative thrombosis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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