背景:在全髋关节置换术(total hip arthroplasty,THA)围术期血液管理中,抗纤溶药物氨甲环酸(tranexamic ac-id,TXA)能有效减少手术失血、降低输血率,重组人促红细胞生成素及铁剂也被用于改善贫血状况.目的:探讨非骨水泥型THA中静脉使用TXA联合术后使用促红细胞生成素和静脉铁剂对输血率、贫血恢复及术后功能恢复的影响.方法:回顾性对比分析2015年7月至2016年4月于我院行初次单侧非骨水泥型THA的患者80例,实验组术中使用TXA联合术后使用促红细胞生成素及铁剂,共40例;对照组术中使用TXA但术后不使用促红细胞生成素及铁剂,共40例.比较两组输血率、术后1周血红蛋白(hemoglobin,Hb)、术后贫血率、术后3个月髋关节Harris评分等.结果:实验组输血率10%,对照组输血率17.5%,差异无统计学意义(P>0.05);实验组术后1周Hb高于对照组[(105.2±16.2)vs(94.9± 11.3)g/L,P<0.01];实验组术后1周贫血发生率低于对照组(61.1% vs 96.9%,P<0.01);实验组出院时髋关节Harris评分与对照组比较,差异无统计学意义[(53.3±10.0)vs(50.3±6.9)分,P>0.05];实验组术后3个月髋关节Harris评分高于对照组[(81.1±7.8)vs(73.7±10.0)分,P<0.01];术后1周Hb与术后3个月Harris评分呈正相关(r=0.440),为术后3个月Harris评分的主要影响因素.两组术后并发症比较差异无统计学意义.结论:对于初次单侧THA,术中使用TXA联合术后使用促红细胞生成素及静脉铁剂相比于仅术中使用TXA而术后不使用促红细胞生成素及静脉铁剂,虽不能降低术后3 d内患者的输血率,但能促进术后Hb恢复,降低贫血发生率,并加快术后早期功能恢复,具有安全性.%Background:In perioperative blood management of total hip arthroplasty, tranexamic acid(TXA)is used to reduce blood loss and transfusion rate. Recombinant human erythropoietin(rhEPO)and intravenous iron are also used to improve anemic status. Objective:To explore the effect of intraoperative administration of intravenous TXA combined with postoperative administration of intravenous iron and rhEPO on blood transfusion rate, anemic recovery and postoperative function recovery in primary unilateral cementless total hip arthroplasty (THA). Methods:A retrospective study was carried out in 80 patients who underwent primary unilateral cementless THA from July 2015 to April 2016, all patients received TXA intraoperatively, including 40 receiving additionally postoperative intravenous iron and rhEPO in the experimental group and 40 not receiving such additional drugs in the control group. The transfusion rate, hemoglobin(Hb)on Day 7, postoperative anemia rate, and Harris Hip Score three months after the operation were compared between the two groups. Results: There was no difference between the experimental group and the control group in transfusion rate (10% vs 17.5%, P> 0.05). Postoperative Hb on Day 7 was higher in the experimental group than in the control group ([105.2±16.2] vs [94.9± 11.3] g/L, P<0.01). The anemia rates on postoperative Day 7 was lower in experimental group than in control group (61.1% vs 96.9%, P<0.01). The Harris Hip Score two weeks after the operation was similar in the two groups ([53.3±10.0] vs [50.3± 6.9], P>0.05), but the Harris Hip Score three months after the operation in experimental group was higher than that in the control group ([81.1±7.8] vs [73.7±10.0], P<0.01). Hb on postoperative Day 7 was positively correlated with Harris Hip Score three months after the operation (r=0.440) and was one of the main influencing factors for Harris Hip Score three months after the operation. There was no difference in postoperative complications between the two groups. Conclusions: For primary unilateral cementless THA, administration of intraoperative intravenous TXA combined with postoperative intravenous iron and rhEPO can not decrease the rate of blood transfusion within 3 days after operation, but it can promote the postoperative anemic recovery and early functional rehabilitation and is also relative safe.
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