【摘要】：[目的]探討氨甲環(huán)酸不同給藥途徑對(duì)全膝關(guān)節(jié)置換術(shù)失血量的影響。[方法]120例擬行初次單側(cè)全膝關(guān)節(jié)置換術(shù)患者,隨機(jī)分為A、B、C、D四組,每組30例。A組在縫合關(guān)節(jié)囊后經(jīng)引流管向關(guān)節(jié)腔內(nèi)灌注溶于50ml生理鹽水的氨甲環(huán)酸(tranexamic acid,TXA)1 g;B組術(shù)前0.5 h靜滴TXA 20 mg/kg+100 ml生理鹽水;C組關(guān)閉關(guān)節(jié)囊前關(guān)節(jié)周?chē)浗M織注射TXA 1 g+100 ml生理鹽水;D組在縫合關(guān)節(jié)囊后向關(guān)節(jié)腔內(nèi)灌注50 ml生理鹽水。記錄圍手術(shù)期失血量、輸血量、輸血率、術(shù)后血紅蛋白濃度和術(shù)后3 h纖維蛋白原、凝血酶原時(shí)間、活化部分凝血活酶時(shí)間、皮下瘀斑、深靜脈血栓形成、患膝周徑變化率等指標(biāo)。[結(jié)果]A、B、C三組和D組兩兩比較,圍手術(shù)期失血量、輸血量和輸血率明顯減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05),A、B、C三組組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后血紅蛋白濃度A、B、C三組明顯高于D組(P0.05),A、B、C三組組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);四組患者術(shù)后3 h纖維蛋白原、凝血酶原時(shí)間和活化部分凝血活酶時(shí)間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。A、B、C三組皮下瘀斑率和患膝周徑變化率低于D組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后未發(fā)現(xiàn)下肢深靜脈血栓形成及肺梗塞、心肌梗塞、腦梗塞等血栓相關(guān)事件發(fā)生。[結(jié)論]在全膝關(guān)節(jié)置換術(shù)中應(yīng)用TXA能明顯減少?lài)中g(shù)期失血量,降低輸血率和輸血量,尤其是關(guān)節(jié)腔內(nèi)灌注TXA既可以減少失血又可以避免靜脈給藥可能帶來(lái)的并發(fā)癥。
[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.
【作者單位】： 內(nèi)蒙古自治區(qū)國(guó)際蒙醫(yī)醫(yī)院;
【分類(lèi)號(hào)】：R687.4

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