| 武辉,全健,雷斌.关节腔和静脉联合应用氨甲环酸对人工全膝关节置换术疗效及出血量的影响[J].安徽医药,2018,22(10):1983-1985. |
| 关节腔和静脉联合应用氨甲环酸对人工全膝关节置换术疗效及出血量的影响 |
| Efficacy of and blood loss in the total knee arthroplasty with the intra-articular and intravenous injection of tranexamic acid |
| 投稿时间：2017-07-05 |
| DOI： |
| 中文关键词: 关节成形术,置换,膝/副作用 手术后出血 氨甲环酸 注射,关节内 注射,静脉内 治疗结果 |
| 英文关键词: Arthroplasty,replacement,knee/adverse effects Postoperative hemorrhage Tranexamic acid Injections,intra-articular Injections,intravenous Treatment outcome |
| 基金项目: |
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| 中文摘要: |
| 目的 研究关节腔和静脉联合应用氨甲环酸对人工全膝关节置换术(TKA)疗效及出血量的影响。 方法 2015年5月至2017年5月,陕西省中医医院共收治86例行TKA患者,以随机数字表法分成观察组43例,对照组43例。观察组患者在止血带松动前20 min行静脉滴注氨甲环酸(10 mg·kg-1)溶液100 mL,术后经引流管向关节腔直接注射1.0 g氨甲环酸,引流管夹闭1 h后行负压吸引；对照组患者在止血带松动前20 min行静脉滴注生理盐水100 mL,术后经引流管向关节腔直接注射1.0 g氨甲环酸,引流管夹闭2 h后行负压吸引。对比观察两组治疗后失血量、凝血功能、临床资料及输血率与深静脉血栓形成(DVT)发生率。 结果 术后观察组在显性失血量与阴性失血量及总失血量方面均明显低于对照组(t=5.674,6.519,7.767；P＜0.001,＜0.001,＜0.001)；术后两组患者在凝血酶原时间(PT)与活化部分凝血活酶时间(APPT)及D-二聚体(D-D)等指标均差异无统计学意义(t=0.258,0.786,1.537；P=0.797,0.434,0.128)；手术后观察组患者血红蛋白与红细胞比容及血体积改变等方面明显不同(t=2.128,3.637,14.604；P=0.036,0.001,＜0.001)；术后两组患者DVT发生率(观察组为13.95%,对照组为18.60%)差异无统计学意义,但输血率观察组(13.95%)明显低于对照组(39.53%)(χ2=7.182,P=0.007)。 结论 关节腔和静脉联合应用TXA对人工膝关节手术患者治疗中,有效降低了术后患者出血量,改善了患者血红蛋白与红细胞比容及血体积,同时还有效降低了患者术中及术后输血率,且不增加DVT发生率,值得临床借鉴。 |
| 英文摘要: |
| Objective To study the effect of combined use of tranexamic acid on total knee arthroplasty (TKA) and the amount of blood loss. Methods Totally 86 patients with TKA who were treated in Shaanxi Hospital of Traditional Chinese Medicinefrom May 2015 to May 2017 were assigned into observation group (n=43) and control group (n=43) by random number table method.In the observation group,100 mL of tranexamic acid (10 mg·kg-1) solution was intravenously infused 20 min before the tourniquet was loosened.;after the operation,1.0g of tranexamic acid was directly injected into the joint cavity through the drainage tube,and the drainage tube was clamped for 1 hour and then subjected to vacuum suction.In the control group,100 mL of normal saline was instilled 20 min before the tourniquet was loosened;after the operation,1.0 g of tranexamic acid was directly injected into the joint cavity through the drainage tube,and the drainage tube was clamped for 2 hours and then underwent vacuum aspiration.The blood loss,coagulation function,clinical data,blood transfusion rate and incidence of DVT were compared between the two groups. Results The postoperative observation group was significantly lower than the control group in terms of dominant blood loss,hidden blood loss and total blood loss (t=5.674,6.519,7.767;P＜0.001,＜0.001,＜0.001).There were no significant differences in PT,APPT and D-D between the two groups (t=0.258,0.786,1.537；P=0.797,0.434,0.128).After operation,hemoglobin,hematocrit and blood volume were significantly changed in the observation group (t=2.128,3.637,4.604;P=0.036,0.001,<0.001).There was no significant difference in the incidence of DVT between the two groups(observation group 13.95% vs. control group 18.60%),but the blood transfusion rate in the observation group(13.95%) was significantly lower than that in the control group(39.53%)(χ2=7.182,P=0.007). Conclusions The intra-articular and intravenous combined application of tranexamic acid in the total knee arthroplasty can effectively reduce the amount of bleeding in postoperative patients,improve patients′ hemoglobin,hematocrit and blood volume,and effectively reduce the blood transfusion rate during and after operation without increasing the incidence of DVT,which is worthy of clinical reference. |
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