3种氨甲环酸用药方式对髋关节置换的止血效果比较-现代医学

3种氨甲环酸用药方式对髋关节置换的止血效果比较

单位：1. 上海交通大学医学院附属同仁医院骨科, 上海 200336;
2. 苏州大学附属第二医院骨科, 江苏苏州 215004

分类号：R687.5

出版年·卷·期（页码）：2018·46·第五期（514-517）

摘要：

目的：探讨3种氨甲环酸用药方式对髋关节置换的止血效果。方法：选取2015年1月至2017年6月200例行髋关节置换术的患者为研究对象。将患者随机分为A、B、C、D 4组，每组50例。其中A组作为对照组，不使用氨甲环酸；B组在关闭伤口后立刻给予100 ml生理盐水+0.5 g氨甲环酸静脉滴注；C组则在缝合关闭伤口前给于患者100 ml生理盐水+3 g氨甲环酸浸泡5 min；D组则在关闭伤口后，通过引流管注射100 ml生理盐水+2 g氨甲环酸。所有患者在术后4 h内完全夹闭引流管，然后完全打开引流，术后48 h拔出引流管。比较4组患者术后的引流量、血红蛋白水平、总失血量、凝血常规以及术后并发症的发生情况。结果：与A组比较，B、C、D 3组患者术后的引流量和总失血量显著较低，且D组最低，差异均有统计学意义（P<0.05）；患者在术后6、24、72 h的血红蛋白水平显著降低，与A组比较，B、C、D 3组患者在术后6、24、72 h的血红蛋白水平显著较高，且D组高于B组和C组，差异均有统计学意义（P<0.05）；4组患者的PT、APTT、TT、FIB水平在术后的组内比较和组间比较以及术后并发症的发生情况比较，差异均无统计学意义（P>0.05）；随访6个月时，D组患者的Harris评分显著高于A组，差异有统计学意义（P<0.05），而下肢深静脉血栓和肺栓塞的发生情况比较，差异均无统计学意义（P>0.05）。结论：氨甲环酸局部用药方式的止血效果优于静脉滴注，并且引流管逆行注射的用药方式效果最好。

Objective: To investigate the effect of three different methods of tranexamic acid on the hemostatic effect of hip replacement.Methods: From January 2015 to June 2017, 200 patients undergoing total hip arthroplasty in Tongren Hospital of Shanghai were enrolled. The patients were randomly divided into four groups:A, B, C and D, 50 cases in each group.Patients in group A as the controls did not use tranexamic acid. Patients in group B received intravenous drip of 100 ml saline + 0.5 g tranexamic acid immediately after wound closure. Patients in group C were treated with 100 ml of saline + 3 g of tranexamic acid for 5 minutes before suture closure of the wound. Patients in group D were injected with 100 ml saline + 2 g tranexamic acid via the drainage tube after the wound was closed. All patients completely clogged the drainage tube within 4 hours after operation, then completely opened and drained, and the drainage lasted 48 hours after the operation. The postoperative drainage volume, hemoglobin level, total blood loss, coagulation routine, and postoperative complications were compared between the four groups.Results: Compared with group A, the drainage volume and total blood loss after operation in group B, C and D were significantly lower, and the difference was statistically significant (P<0.05). The hemoglobin level of patients at 6 h, 24 h and 72 h after operation was significantly decreased. Compared with A group, the hemoglobin level of three groups of B, C and D was significantly higher at 6 h, 24 h and 72 h after operation, and the level of Hb ingroup D was higher than that in groupB and group C. There was no significant difference in PT, APTT, TT and FIB levels among the four groups after intraoperative comparisons and between groups, and postoperative complication. At 6 months of follow-up, the Harris score in group D was significantly higher than that in group A (P<0.05), while there was no significant difference in the incidence of deep vein thrombosis and pulmonary embolism (P>0.05).Conclusion: Local administration of tranexamic acid has a better hemostatic effect than intravenous infusion does, and the retrograde injection of drainage tube has the best effect.

参考文献：

[1] 杨宇翔,肖杰,马翅,等.全髋关节置换术中静脉联合局部应用氨甲环酸的安全性与有效性[J].实用医药杂志,2017, 34(11):970-973.
[2] 刘金望, 林炎水, 蒋涛,等. 氨甲环酸对老年陈旧性股骨颈骨折伴骨质疏松行髋关节置换术失血的影响[J].中国老年学, 2017, 37(1):148-150.
[3] 熊文, 郭孝军, 曾广军,等. 氨甲环酸不同给药方式对全髋关节置换术患者凝血功能和出血量的影响[J].临床骨科杂志, 2017, 20(4):452-455.
[4] 王井伟, 任淑华. 局部应用氨甲环酸联合肾上腺素对减少全髋关节置换术失血量的影响[J].实用医学杂志, 2017, 33(2):279-281.
[5] 陶家停, 尹宗生, 高维陆,等. 全髋关节置换术中全身及局部联合应用氨甲环酸的止血效果观察[J].山东医药, 2017, 57(7):77-79.
[6] CHOI W K, CHO M R, KIM H S,et al. Results of primary total hip arthroplasty using 36 mm femoral heads on 1st generation highly cross linked polyethylene in patients 50 years and less with minimum five year follow-up[J].Hip Pelvis, 2016, 28(2):76-81.
[7] 赵清斌, 任姜栋, 张晓岗,等. 氨甲环酸静脉或局部及联合应用初次单侧全髋关节置换:围置换期出血及输血率的比较[J].中国组织工程研究, 2016, 20(4):459-464.
[8] CHEN S, WU K, KONG G, et al. The efficacy of topical tranexamic acid in total hip arthroplasty:a meta-analysis[J].BMC Musculoskeletal Disorders, 2016, 17(1):1-7.
[9] DAHUJA A, DAHUJA G, JASWAL V, et al. A prospective study on role of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty and its effect on coagulation profile[J].J Arthroplasty, 2014, 29(4):733-735.
[10] JENNINGS J D, SOLARZ M K, CHRISTOPHER H. Application of tranexamic acid in trauma and orthopedic surgery[J].Orthop Clin North Am, 2016, 47(1):137-143.
[11] SUN X, DONG Q, ZHANG Y G. Intravenous versus topical tranexamic acid in primary total hip replacement:a systemic review and meta-analysis[J].Int J Surg, 2016, 32(50):10-18.

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