目的：探讨氨甲环酸减少同期双侧人工全膝关节置换术围手术期出血的有效性和安全性。方法选择2012年5月～2015年1月同期行双侧人工全膝置换术患者83例，2013年7月以前手术患者45例为对照组，2013年7月以后手术患者38例为观察组。两组均采用全身或椎管麻醉、于止血带下完成手术。观察组上止血带前静滴氨甲环酸1 g（10 mL），手术结束后关节腔内注射氨甲环酸4 g；对照组未使用氨甲环酸。记录两组术后引流量、总失血量、隐性出血量、输血率、输血量、血红蛋白水平、血小板计数以及症状性静脉栓塞发生情况。结果观察组与对照组术后总引流量分别为（177．8±166．7）和（509．9±326．4）mL，总失血量分别为（678．1±366．1）和（1581．9±563．0）mL，隐性失血量分别为（500．3±298．6）和（1089．0±578．0）mL，总输血量分别为（1．4±1．9）和（5．5±2．9）U，输血率分别为44．7％（17／38）和97．8％（44／45），两组比较P均＜0．01；观察组与对照组术后第5天血红蛋白水平分别为（100．8±112．4）和（95．1±10．5）g／dL，两组比较P＜0．01；观察组与对照组术后血小板计数、发生症状性静脉血栓情况比较均无统计学差异（P均＞0．05）。结论静滴结合关节内注射氨甲环酸可减少同期双侧人工全膝关节置换术术后出血量，且不增加血栓发生风险。%Objective To investigate the efficacy and safety of tranexamic acid in reducing perioperative bleeding dur-ing simultaneous bilateral total knee arthroplasty (TKA).Methods From May 2012 to January 2015, 83 cases of patients who underwent simultaneous bilateral TKA were retrospectively analyzed.During 83 cases of patients, 45 cases of patients re-ceived the operation before July 2013 who were taken as the control group and 38 cases of patients received the operation after July 2013 who were taken as the observation group.We all used the general or spinal canal anesthesia in the two groups, and completed the operation in a tourniquet.In the observation group, 1 g (10 mL) tranexamic acid was injected into the vein be-fore using a tourniquet, and 4 g tranexamic acid was then given by intra-articular injection after the surgery;while we did not use tranexamic acid in the control group.Total blood loss, drain volume, hidden blood loss, transfusion volume, transfusion rate, hemoglobin, PLT and venous thromboembolism were recorded in the two groups.Results The total volume of drainage in the observation group and control group was respectively (177.8 ±166.7) and (509.9 ±326.4) mL, total blood loss was respectively (678.1 ±366.1) and (1 581.9 ±563.0) mL, the hidden blood loss was respectively (500.3 ±298.6) and (1 089.0 ±578.0) mL, total amount of blood transfusion was respectively (1.4 ±1.9) and (5.5 ±2.9) U, blood transfu-sion rate was 44.7%(17/38) and 97.8%(44/45), and significant difference was found between these two groups (all P<0.01).The hemoglobin levels were respectively (100.8 ±112.4) and (95.1 ±10.5) g/dL on the fifth day after the opera-tion of the two groups and significant difference was found between these two groups (P<0.01).There was no difference in the platelet counting or symptomatic venous thromboembolism ( VTE) between the observation group and control group ( all P >0.05).Conclusion The combination of intravenous and intra-articular injection of tranexamic acid could significantly re-duce blood loss for simultaneous bilateral TKA and it does not increase the risk of VTE.
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