| 氨甲环酸的不同给药方式对减少初次全髋关节置换术后隐性出血的病例对照研究 |
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Received:April 17, 2016
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| 期刊信息：《中国骨伤》2016年29卷，第8期，第713-717页 |
| DOI：10.3969/j.issn.1003-0034.2016.08.008 |
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| 目的：比较氨甲环酸不同给药方式对减少全髋关节置换术后隐性失血的临床疗效。方法：自2010年2月至2015年7月收治股骨头坏死患者68例，均接受初次人工全髋关节置换术，术前按照随机分组原则分为静脉应用组（A组）和局部应用组（B组）.A组男19例，女15例，平均年龄（62.0±6.4）岁，血红蛋白（121.33±8.15）g/L，红细胞比容（0.470±0.039）L/L;B组男18例，女16例，平均年龄（64.0±7.5）岁，血红蛋白（125.28±9.37）g/L，红细胞比容（0.490±0.041）L/L.手术切口采用统一的后外侧入路并按照常规手术方式手术，假体选择生物型假体。通过不同途径给予氨甲环酸控制术中及术后出血。静脉应用组：于术前10 min给予10 mg/kg氨甲环酸溶于150 ml生理盐水中静脉滴注。局部应用组（B组）:将3 g氨甲环酸溶于120 ml的生理盐水中并分成3等份，用2块纱布浸入40 ml氨甲环酸溶液，分别填塞于在髋臼锉刨削好髋臼壁和股骨侧扩髓之后的髓腔内，持续5 min.剩余40 ml在切口关闭之前注射入关节腔内，放置引流管并将引流管夹闭3 h后开放。术后72 h检测并比较两组患者血红蛋白、红细胞比容等血液学指标，计算总失血量、显性失血量和隐性失血量、输血例数，比较两组患者的术后凝血功能。结果：术后A组手术前后血红蛋白差值（32.34±7.42）g/L，总失血量（833.6±81.4）ml，隐性失血量（276.3±57.9）ml，红细胞比容（10.1±1.4）L/L;B组手术前后血红蛋白差值（28.2±6.1）g/L，总失血量（792.5±61.8）ml，隐性失血量（297.5±50.3）ml，红细胞比容（9.2±1.2）L/L，两组比较差异无统计学意义。术后A组PT（12.78±2.03）s，APTT（34.27±3.91）s，INR 32.34±7.42;B组PT（13.17±2.19）s，APTT（32.36±3.18）s，INR 28.24±6.14，两组差异无统计学意义。超声检查证实两组患者均无下肢深静脉血栓形成。A组术中出血明显少于B组。结论：静脉应用氨甲环酸与局部应用氨甲环酸能同样有效地减少初次全髋关节置换术后总失血量和隐性失血量，减少术后输血率，并没有增加下肢静脉血栓的风险。 |
| [关键词]:关节成形术,置换,髋 氨甲环酸 隐性失血 病例对照研究 |
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| Comparison of different modes of using tranexamic acid administration on reducing hidden blood loss in total hip arthroplasty |
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| Abstract:Objective: To compare the clinical efficacy of using tranexamic acid in different ways to reduce the hidden blood loss in patients who receiving total hip arthroplasty(THA). Methods: Totally 68 patients with osteonecrosis of the femeral head treated by total hip arthroplasty in our hospital from February 2010 to July 2015 were randomly divided into the intravenous drip group (group A) and the topical application group(group B). In group A,there were 19 males and 15 females,with an average age of(62.0±6.4) years old,preoperative average hemoglobin was(121.30±8.15) g/L,average Hematocrit was (0.470±0.039) L/L. In group B,there were 18 males and 16 females,with an average age of(64.0±7.5) years old,preoperative average hemoglobin was(125.28±9.37) g/L,average Hematocrit was(0.490±0.041) L/L. The operation incision were performed through the posterolateral approach and the normal operation mode,biological prosthesis was selected. Through different ways the tranexamic acid was used to control of intraoperative and postoperative bleeding. Tranexamic acid was intra-articular injection as a dose of 10 mg/kg 10 min to patient before anesthesia in intravenous drip group. In topic group,3 g of tranexamic acid was dissolved in 120 ml saline and divided into three equal parts,then two pieces of gauze were immersed in 40 ml tranexamic acid solution. One gauze with 40 ml tranexamic acid was used to soak the acetabulum for 5 minutes after the acetabular preparation,another gauze was inserted in the femoral canal for 5 minutes after femoral canal broach preparation. The remaining 40 ml tranexamic acid fluid was injected into the hip joint after fascia closure. Place the drainage tube and clip it for 3 hours. Hemoglobin(Hb) and Hematocrit(Hct) were recorded at 72 hours after operation. The total blood loss,dominant blood loss,and hidden blood loss were calculated. Results: In group A,postoperative hemoglobin difference before and after operation was(32.34±7.42) g/L,total blood loss was(833.6±81.4) ml,the hidden blood loss was(276.3±57.9) ml,red blood cell volume was(10.1±1.4) L/L;In group B,hemoglobin difference before and after operation was (28.2±6.1) g/L,total blood loss was(792.5±61.8) ml,the hidden blood loss was (297.5±50.3) ml,red blood cell volume was (9.2±1.2) L/L. There was no statistical significance about those aspect(P>0.05). Compared of blood coagulation function between two groups,in group A:PT (12.78±2.03) s,APTT (34.27±3.91) s,INR (32.34±7.42);and in group B:PT(13.17±2.19) s,APTT (32.36±3.18) s,INR(28.24±6.14). There was no significant differences also(P>0.05). Conclusion: Compared with intravenous application,topical application of tranexamic acid could also effectively reduce total blood loss and hidden blood loss,postoperative blood transfusion rate in primary total hip arthroplasty,while does not increase the risk of DVT. |
| KEYWORDS:Arthroplasty,replacement,hip Tranexamic acid Hidden blood loss Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 倪进荣,王立新,陈新军.氨甲环酸的不同给药方式对减少初次全髋关节置换术后隐性出血的病例对照研究[J].中国骨伤,2016,29(8):713~717 |
| 英文格式: | NI Jin-rong,WANG Li-xin,and CHEN Xin-jun.Comparison of different modes of using tranexamic acid administration on reducing hidden blood loss in total hip arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(8):713~717 |
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