全膝关节置换术全身局部联合序贯应用氨甲环酸的有效性及安全性研究

发布时间：2019-04-02 19:43

【摘要】：目的:研究氨甲环酸(tranexmic acid,TXA)不同给药方式对全膝关节置换术(total knee arthroplasty,TKA)围手术期总失血量的影响。方法:将70例行单侧初次TKA的患者随机分为3组:局部应用TXA为A组(n=24);序贯联合使用TXA为B组(n=23)。关节腔内注射等量生理盐水为C组(n=23)。围手术期检测患者的总失血量、输血量、输血率、引流量、下肢周径、D二聚体、血栓弹力图。结果:A、B、C组围手术期平均总失血量分别为(541±210)、(456±216)、(731±179)ml;A、B、C组术后24 h平均引流量分别为(104±44)、(98±48)、(160±60)ml。总失血量及引流量方面C组与A、B组比较有统计学差异(P0.05),A、B组之间没有统计学差异(P0.05)。3组患者在输血量、输血率、下肢周径方面结果没有统计学差异(P0.05)。A组患者中发生了1例下肢深静脉血栓,其余患者均没有下肢深静脉血栓(deep vein thrombosis,DVT)的发生(P0.05)。结论:TXA序贯联合应用组的总失血量和引流量较局部应用组少,但在统计学上没有差异。两者在输血量、输血率、下肢周径方面结果没有统计学差异。2种用药方式均不会增加下肢深静脉血栓发生的风险。
[Abstract]:Aim: to study the effect of different administration methods of tranexmic acid,TXA on the total blood loss during the perioperative period of total knee arthroplasty (total knee arthroplasty,TKA). Methods: 70 patients with unilateral primary TKA were randomly divided into 3 groups: group A (n = 24) received local TXA and group B (n = 23) received sequential combination of TXA (n = 23). The same amount of saline was injected into the articular cavity as group C (n = 23). Total blood loss, blood transfusion rate, drainage flow, peripheral diameter of lower limbs, D dimer and thrombus elastogram were measured during perioperative period. Results: the mean total blood loss in group A, B and C was (541 卤210), (), 456 卤216), (731 卤179) ml. at 24 h after operation in group A, B and C, respectively (104 卤44), (98 卤48), (160 卤60) ml. at 24 h after operation in group A, B and C, respectively. The total blood loss and drainage volume in group C was statistically different from that in group A and B (P0.05), but there was no statistical difference between group A and group B (P0.05). 3 groups of patients in the volume of blood transfusion, blood transfusion rate, there was no significant difference between group A, group B (P0.05). There was no significant difference in the peripheral diameter of lower extremities (P 0.05). There was no significant difference in deep venous thrombosis (deep vein thrombosis,DVT) in the). A group (P0.05). Conclusion: the total blood loss and drainage volume in the sequential combination of TXA group were less than those in the local group, but there was no statistical difference between the two groups. There was no significant difference in blood transfusion volume, blood transfusion rate and lower limb circumference between the two groups. Neither of the two methods increased the risk of deep venous thrombosis of the lower limbs.
【作者单位】：重庆医科大学附属第一医院骨科;
【分类号】：R687.42

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