全膝关节置换术（TKA）时骨与软组织出血常会导致大量血液丢失。初次置换时累计失血量可达500～1500 ml。围手术期大量失血常常需要同种异体输血来维持血红蛋白以及红细胞压积的水平。同种异体输血常常导致免疫抑制，输血反应，移植物抗宿主病和感染的发生。为了避免这些问题并且降低输血的费用，可采用多种术中药物治疗策略。目前，这些药物包括氨甲环酸，6-氨基己酸，纤维蛋白，凝血酶，肾上腺素以及去甲肾上腺素。然而，这些药物的效果以及成本收益往往不同。我们对全膝关节置换术术中药物治疗方法进行总结，并讨论应用药物可能带来的并发症。%Bone and soft tissue bleeding often results in substantial amounts of blood loss during the total knee arthroplasty(TKA). Multiple studies have reported that cumulative blood loss varies from 500 to 1500 mL in primary settings. Increased perioperative blood loss frequently requires allogeneic blood transfusions to improve the hematocrit and hemoglobin levels. However,allogeneic transfusion is associated with risks of immunosuppression,transfusion reactions,graft versus host disease,and transmission of infec-tions. To avoid these problems and reduce costs of transfusion,multiple intraoperative pharmacotherapeutic strategies have been developed. The various pharmacotherapeutic agents currently used include tranexamic acid,epsilon-aminocaproic acid,fibrin,thrombin,lavage with epinephrine,and norepinephrine. However, the relative efficacy and the cost-effectiveness of these agents may vary. Thus,the purpose of this study was to provide a brief overview of the relative efficacy of various intraoperative pharmacological methods cur-rently in use for decreasing blood loss following TKA and describe their potential complications associated with their application.
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