氨甲环酸不同给药方式对髋关节置换 围手术期出血的影响研究

Clinical study of different administrationof Tranexamic acid on perioperative bleeding of total hip arthroplasty

摘要:

目的 探讨3 种不同给药方式应用氨甲环酸减少单侧全髋关节置换（THA）围手术期失血效率和 安全性。方法 选取2015 年1 月-2017 年3 月该院初次接受单侧THA 的患者40 例，将其随机分为3 组。A 组（12 例）：氨甲环酸（TXA）关节腔局部注射给药；B 组（14 例）：TXA 静脉滴注给药联合关节腔局部注射给药； C 组（14 例）：术中喷洒和浸药纱布覆盖创面联合关节腔局部注射给药。比较3 组围手术期显性失血量、隐 性失血量、输血率、平均输血量、凝血功能及血栓性并发症的发生率。结果 3 组间术前一般资料、住院时 间、输血率、术前血红蛋白（HGB）含量及并发症发生率比较，差异无统计学意义（P >0.05）。C 组失血量 和平均输血量低于A、B 组（P <0.05），A、B 组间比较差异无统计学意义（P >0.05）；3 组术后HGB 水平较 术前降低（P <0.05），C 组HGB 高于A、B 组（P <0.05）；手术前后3 组间D- 二聚体（DD）、纤维蛋白素 （FIB）、凝血酶原时间（PT）及活化部分凝血活酶时间（APTT）比较，差异无统计学意义（P >0.05），3 组术 后的FIB 含量较术前降低（P <0.05），APTT 较术前延长（P <0.05）。结论 局部用药优于静脉给药，可安全有 效减少THA 围手术期出血。

Abstract:

Objective To discuss the efficacy and safety of Tranexamic acid (TXA) in reducing the perioperative blood loss of total hip arthroplasty by different ways of administration. Methods Forty patients undergoing unilateral total hip arthroplasty were randomly assigned to three groups. In group A (n = 12), TXA was injected locally into joint cavity. In group B (n = 14), TXA was intravenous infused combined with locally injection in joint cavity. In group C (n = 14), TXA was intraoperatively locally sprayed combined withlocally injected in joint cavity. The dominant blood loss, occult blood loss, blood transfusion rate, average transfusion volume, coagulation function and thrombotic complications were compared among the groups. Results The preoperative general data, hospital stay, blood transfusion rate, preoperative HGB content and complication rate were not significantly different in three groups (P > 0.05). The blood loss and average transfusion volume in group C were significantly lower than those in group A and group B (P < 0.05), while there was no significant difference between group A and group B (P > 0.05). The level of HGB in three groups was significantly lower than that before operation (P < 0.05). The level of HGB in group C was significantly higher than that in group A and B (P < 0.05). There were no significant differences for DD, FIB, PT and APTT in three groups before and after operation (P > 0.05). The content of FIB in three groups was significantly lower than that before operation, and APTT was significantly longer (P < 0.05). Conclusion Local medication is better than intravenous administration, and it can reduce the perioperative bleeding of total hip replacement safely and effectively.