全髋置换局部应用氨甲环酸后输血及成本效益分析

摘要

Objective To investigate the effects of topical Tranexamic Acid technique on blood loss,transfusion and cost benefit in total hip arthroplasty(THA). Methods 80 patients underwent THA from Mar 2013 to Mar 2014 were enrolled and randomly divided into Tranexamic acid group(T group,n = 40)or Control group(C group,n = 40). In T group 2. 0 g tranex-amic acid(20 mL)were prepared. 10 mL were injected peri ﹣ articularly after prosthesis was on position. 10 mL were injected intro ﹣ articularly after iliotibial band was sutured. In C group,20 mL saline were prepared,the administration was the same with T group. visible blood loss,hidden blood loss,blood transfusion per patient,24-hour postoperative red blood cell count,he-moglobin,hematocrit,3-hour postoperative prothrombin time and activated partial thromboplastin time were recorded and com-pared. Total transfusion cost,total hospitalization cost,cost per-patient,cost-benefit ratio were recorded and counted. Results Significant differences were found in visible blood loss,hidden blood loss,blood transfusion per-patient,24-hour postoperative red blood cell count,hemoglobin,hematocrit(P ﹤ 0. 05),suggesting better blood loss control in T group than C group. No sig-nificant difference in 3-hour postoperative prothrombin time and activated partial thromboplastin time(P ﹥ 0. 05). The cost of transfusion,hospitalization,per patient were lower in T group than C group. Cost-benefit ratio was 29. 164. Conclusion Topi-cal Tranexamic Acid technique in total hip arthroplasty can obviously decrease postoperative blood loss and per patient blood transfusion,and cut down the cost of hospitalization,showing good advantage in cost-benefit control.%目的：研究全髋置换术后局部应用氨甲环酸的输血及成本效益分析。方法研究选取2013年5月至2014年5月行全髋关节置换的患者80例，随机分为氨甲环酸组（T 组）40例，对照组（C 组）40例。T 组取2.0 g（20 mL）氨甲环酸，于假体安装完毕后关节周围浸润注射10 mL，髂胫束缝合后关节腔内注射10 mL。C 组使用20 mL 生理盐水，按 T 组方法局部应用。比较两组术后显性、隐性失血量、人均输血量、术后24 h 红细胞计数（ red blood cell count， RBC）、血红蛋白（hemoglobin，Hb）、红细胞比容（hematocrit，Hct）、术后3 h 凝血酶原时间（prothrombin time，PT）和活化部分凝血活酶时间（activated partial thromboplatin time，APTT）。比较两组患者输血总费用、住院总费用、人均住院费用，计算成本效益比。结果两组患者显性、隐性失血量、人均输血量、术后24 h RBC、HB、HCT 比较差异有统计学意义（P ﹤0.05），T 组明显优于 C 组。术后3 h PT 和 APTT 差异无统计学意义（P ﹥0.05）。T 组输血总费用、住院总费用、人均住院费用较 C 组减少，成本效益比为29.164。结论全髋关节置换术中局部应用氨甲环酸不仅明显降低术后失血量及人均输血量，还可节约住院费用，具有良好的成本效益优势。