2018 年第 8 期 第 13 卷

静脉滴注氨甲环酸对膝关节置换手术患者失血量及血栓性并发症的影响

Effect of intravenous administration of tranexamic acid on blood loss and thrombotic complication in patients undergoing knee joint replacement surgery

作者：全生炳陈建华鲍义章

英文作者：

单位：810005西宁市第三人民医院骨二科

英文单位：

关键词：膝关节置换手术；氨甲环酸；失血量；血栓性并发症

英文关键词：

• 摘要：

• 【摘要】目的    探讨静脉滴注氨甲环酸对膝关节置换手术患者失血量及血栓性并发症的影响。方法    选取2014年6月至2017年6月于西宁市第三人民医院行膝关节置换手术患者121例，完全随机分为观察组（61例）与对照组（60例），观察组于全身麻醉诱导期静脉滴注氨甲环酸10 ml/kg，对照组全身麻醉诱导期静脉滴注0.9%氯化钠溶液，比较2组患者失血量、血栓性并发症与膝关节康复情况的差异。结果    观察组输血率低于对照组［16.4%（10/61）比43.3%（26/60）］，差异有统计学意义（P=0.005）。2组术中失血量比较差异无统计学意义（P>0.05），观察组术后引流量、显性失血量、隐性失血量、输血量与总失血量均明显少于对照组［(391±61)ml比(481±90)ml，(500±92)ml比(587±103)ml，(361±52)ml比(456±64)ml，(232±91)ml比(404±169)ml，(862±116)ml比(1 044±182)ml］，差异均有统计学意义（均P<0.001）。2组患肢皮下瘀斑、深静脉血栓形成与肺栓塞发生率比较差异均无统计学意义（均P>0.05）。术前，2组小腿周径、髌上10 cm周径比较差异均无统计学意义（P>0.05）。术后2周，观察组小腿周径、髌上10 cm周径均短于对照组与本组术前，差异均有统计学意义（均P<0.001）。术前，2组美国膝关节协会评分（KSS评分）比较差异无统计学意义（P>0.05）。术后2周，2组KSS评分均高于术前，且观察组高于对照组，差异均有统计学意义（均P<0.001）。结论    静脉滴注氨甲环酸有助于减少膝关节置换手术患者失血量，改善膝关节康复程度，且不增加血栓性并发症的风险。

• Objective    To explore the effect of intravenous administration of tranexamic acid on blood loss and thrombotic complication in patients undergoing knee joint replacement surgery. Methods    Totally 121 patients undergoing knee joint replacement surgery from June 2014 to June 2017 in the Third People′s Hospital of Xining were randomly divided into observation group（n＝61） and control group（n＝60）. The observation group had intravenous administration of tranexamic acid and the control group had intravenous administration of 0.9% sodium chloride solution during anesthesia induction. Blood loss volume, occurrence of thrombotic complications and knee rehabilitation were analyzed. Results    Blood transfusion rate in observation group was significantly lower than that in control group［16.4%（10/61）vs 43.3%（26/60）］（P=0.005）. Intraoperative blood loss showed no significant difference between groups(P>0.05). Postoperative drainage, dominant blood loss, hidden blood loss, blood transfusion volume and total blood loss in observation group were significantly less than those in control group［(391±61)ml vs (481±90)ml， (500±92)ml vs (587±103)ml， (361±52)ml vs (456±64)ml， (232±91)ml vs (404±169)ml， (862±116)ml vs (1 044±182)ml］（P<0.001）. Incidences of limb subcutaneous ecchymosis, deep venous thrombosis and pulmonary embolism showed no significant difference between groups(P>0.05). Before surgery, crus circumference and suprapatellar 10 cm circumference had no significant differences between groups(P>0.05). Two weeks after surgery, crus circumference and suprapatellar 10 cm circumference in observation group were significantly less than those before surgery and those in control group（P<0.001）. Before surgery, American Knee Society knee score (KSS) had no significant difference between groups(P>0.05). After surgery, KSS significantly increased in both groups; KSS in observation group was significantly higher than that in control group（P<0.001）. Conclusion    Intravenous infusion of tranexamic acid helps to reduce blood loss and promote knee joint rehabilitation in patients undergoing knee replacement surgery; it does not increase the risk of thrombotic complication.