【摘要】：[目的]單中心大樣本連續(xù)病例觀察性研究旨在探討初次全髖關(guān)節(jié)置換術(shù)中使用氨甲環(huán)酸對術(shù)后靜脈血栓栓塞癥的影響及THA圍手術(shù)期抗纖溶與抗凝平衡的初步臨床療效。[方法]基于國家衛(wèi)生行業(yè)數(shù)據(jù)庫平臺,前瞻性收集本中心行初次單側(cè)全髖關(guān)節(jié)置換術(shù)患者的基本資料,納入患者圍手術(shù)期靜脈或靜脈聯(lián)合局部使用氨甲環(huán)酸抗纖溶,術(shù)后6 h開始序貫使用低分子肝素或利伐沙班抗凝。主要觀察指標為血栓發(fā)生情況及術(shù)后30 d全因死亡人數(shù);次要指標為輸血率;同時根據(jù)氨甲環(huán)酸使用方式進行亞組分析。[結(jié)果]2012~2014年,共納入本中心初次單側(cè)全髖關(guān)節(jié)置換術(shù)患者3 043例。共有199例(6.54%)發(fā)生術(shù)后血栓栓塞事件,其中肌間靜脈血栓183例(6.01%),非癥狀性深靜脈血栓16例(0.53%),無發(fā)生癥狀性深靜脈血栓、肺栓塞及死亡患者;186例(6.1%)患者接受輸血。亞組分析結(jié)果提示靜脈聯(lián)合局部使用氨甲環(huán)酸較單純靜脈使用術(shù)后輸血率更低(5.4%Vs 7.2%),差異有統(tǒng)計學意義(P=0.039);深靜脈血栓的發(fā)生率并沒有增加(0.6%Vs 0.4%,P=0.578)。[結(jié)論]THA圍手術(shù)期使用TXA抗纖溶后,序貫抗凝維持兩者平衡,可安全的減少圍手術(shù)期輸血率。
[Abstract]:[objective] to investigate the effect of carbamoic acid on venous thromboembolism after primary total hip arthroplasty and the preliminary clinical effect of antifibrinolysis and anticoagulant balance in THA perioperative period. [methods] based on the National Health Industry Database platform, the basic data of patients undergoing primary unilateral total hip arthroplasty in our center were collected prospectively, and the patients were included in the perioperative period of local use of carbamoic acid and fibrinolysis. Low molecular weight heparin (LMWH) or rivastaban were used in sequential anticoagulant therapy 6 hours after operation. The main outcome measures were the incidence of thrombus and the total death toll 30 days after operation, the secondary index was blood transfusion rate, and the subgroup analysis was carried out according to the use of carbamoic acid. [results] from 2012 to 2014, 3 043 patients with primary unilateral total hip arthroplasty were enrolled. There were 199 cases (6.54%) of postoperative thromboembolism, including 183 cases (6.01%) of intermuscular venous thrombosis and 16 cases (0.53%) of non-symptomatic deep venous thrombosis, no symptomatic deep venous thrombosis, pulmonary embolism and death, 186 cases (6.1%) received blood transfusion. The results of subgroup analysis showed that the blood transfusion rate was lower (5.4%Vs 7.2%) and the incidence of deep venous thrombosis was not increased (0.6%Vs 0.4g / P0. 578). [conclusion] after anti fibrinolysis of TXA in THA perioperative period, sequential anticoagulant and anticoagulant balance can be maintained and blood transfusion rate can be reduced safely during perioperative period.
【作者單位】： 四川大學華西醫(yī)院骨科;
【基金】：衛(wèi)生部2013年度衛(wèi)生行業(yè)科研專項項目(編號:201302007)
【分類號】：R687.4
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本文編號：2288113