氨甲环酸不同给药途径对膝关节置换失血量的影响

发布时间：2019-06-05 22:38

【摘要】：[目的]探讨氨甲环酸不同给药途径对全膝关节置换术失血量的影响。[方法]120例拟行初次单侧全膝关节置换术患者,随机分为A、B、C、D四组,每组30例。A组在缝合关节囊后经引流管向关节腔内灌注溶于50ml生理盐水的氨甲环酸(tranexamic acid,TXA)1 g;B组术前0.5 h静滴TXA 20 mg/kg+100 ml生理盐水;C组关闭关节囊前关节周围软组织注射TXA 1 g+100 ml生理盐水;D组在缝合关节囊后向关节腔内灌注50 ml生理盐水。记录围手术期失血量、输血量、输血率、术后血红蛋白浓度和术后3 h纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间、皮下瘀斑、深静脉血栓形成、患膝周径变化率等指标。[结果]A、B、C三组和D组两两比较,围手术期失血量、输血量和输血率明显减少,差异有统计学意义(P0.05),A、B、C三组组间比较差异无统计学意义(P0.05);术后血红蛋白浓度A、B、C三组明显高于D组(P0.05),A、B、C三组组间比较差异无统计学意义(P0.05);四组患者术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间比较差异无统计学意义(P0.05)。A、B、C三组皮下瘀斑率和患膝周径变化率低于D组,差异有统计学意义(P0.05)。术后未发现下肢深静脉血栓形成及肺梗塞、心肌梗塞、脑梗塞等血栓相关事件发生。[结论]在全膝关节置换术中应用TXA能明显减少围手术期失血量,降低输血率和输血量,尤其是关节腔内灌注TXA既可以减少失血又可以避免静脉给药可能带来的并发症。
[Abstract]:Objective to investigate the effect of different administration of carbamaric acid on blood loss in total knee arthroplasty. [methods] 120 patients undergoing primary unilateral total knee arthroplasty were randomly divided into four groups: group A (n = 30), group C (n = 30) and group D (n = 30). (tranexamic acid, (tranexamic acid, dissolved in 50ml saline was perfused into the joint cavity through drainage tube after the joint capsule was sutured. TXA) 1 g; In group B, TXA 20 mg/kg 100 ml saline was injected intravenously 0.5 h before operation, TXA 1 g 100 ml saline was injected into the soft tissue around the anterior joint of the joint capsule in group C, and 50 ml saline was infused into the joint cavity in group D after the joint capsule was sutured. The perioperative blood loss, transfusion rate, hemoglobin concentration, fibrin, prothrombin time, activated partial thromboplastin time, subcutaneous ecchymosis and deep venous thrombosis were recorded. The change rate of knee circumference and other indexes. [results] there were significant differences in perioperative blood loss, transfusion volume and transfusion rate between group C and group D (P 0.05). There was no significant difference among the three groups (P 0.05). The hemoglobin concentration in group A, group B and group C was significantly higher than that in group D (P 0.05). There was no significant difference in hemoglobin concentration between group B and group C (P 0.05). There was no significant difference in fibrin, prothrombin time and activated partial thromboplastin time among the four groups at 3 h after operation (P 0.05). A, B, C group was lower than D group in subcutaneous ecchymosis rate and knee circumference change rate, and there was no significant difference in fibrin, prothrombin time and activated partial thromboplastin time among the four groups at 3 h after operation (P 0.05). The difference was statistically significant (P 0.05). No deep venous thrombosis of lower extremity and thrombus related events such as pulmonary infarction, myocardial infarction and cerebral infarction were found after operation. [conclusion] the application of TXA in total knee arthroplasty can significantly reduce perioperative blood loss, blood transfusion rate and blood transfusion volume, especially intra-articular infusion of TXA can not only reduce blood loss but also avoid complications caused by intravenous administration.
【作者单位】：内蒙古自治区国际蒙医医院;
【分类号】：R687.4

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