全膝关节置换中静脉和局部应用氨甲环酸的止血效果对比

摘要

Objective To find a more suitable approach for the application of tranexamic acid(TXA)on total knee arthroplas‐ty (TKA) .Methods Totally 60 patients who met the inclusion criteria from January 2014 to August 2015 in the First Affiliated Hospital of Shihezi University were selected and divided into two groups according to the different route of administration .Group A (n=30) was intravenously injected with 100 mL TXA ,and group B(n=30) was locally injected with 100 mL TXA .Three hours drainage tubes occlusion were carried out after operation in the two groups .The intraoperative and postoperative dominant blood loss ,hidden blood loss indexes and the amount of total blood loss were recorded ,and coagulation indexes and D‐2 polymer were reg‐ularly monitored ,the incidence of thrombosis and postoperative adverse events were also observed .Results The amount of total blood loss in group B[(895 .41 ± 239 .02)mL] was lower than that in group A[(1 020 .89 ± 210 .83)mL] ,and the difference was statistically significant (P<0 .05);the total drainage volume in group B[(294 .33 ± 54 .25) mL] was lower than that in group A [(373 .33 ± 48 .02)mL] ,and the difference was statistically significant (P<0 .05) .After operation ,there was no significant differ‐ence between the two groups in coagulation indexes ,D‐2 polymer and the amount of hidden blood loss (P>0 .05) .No blood trans‐fusion ,symptomatic deep venous thrombosis and fatal pulmonary embolism occurred in the two groups .Conclusion The hemostatic effect of local application of TXA is better than that of intravenous injection in patients′initial TKA .%目的：寻找一种更适合全膝关节置换术（TKA）的氨甲环酸（TXA）应用途径。方法选取2014年1月至2015年8月石河子大学第一附属医院符合纳入标准的60例患者，根据不同的给药方法将其分为A、B两组，A组（n＝30）静脉滴入100 mL TXA ，B组（n＝30）局部注入100 mL TXA ，两组术后均夹闭引流管3 h。记录术中、术后显性失血量与隐性失血量相关指标、总失血量，定期监测两组患者的凝血指标及D‐二聚体水平，观察血栓发生率与术后不良事件。结果 B组患者总失血量[（895．41±239．02）m L ]低于A组[（1020．89±210．83）m L ]，差异有统计学意义（ P＜0．05）；且术后总引流量B组[（294．33±54．25）m L ]亦低于A组[（373．33±48．02）m L ]，差异有统计学意义（ P＜0．05）；术后的凝血指标、D‐二聚体和隐性失血量两组比较，差异均无统计学意义（P＞0．05）。两组均未出现输血、症状性深静脉血栓、致死性肺栓塞。结论初次行TKA的患者局部应用TXA其初期止血效果优于静脉滴注。