摘要目的 探讨氨甲环酸(tranexamic acid，TXA)不同给药方案在胫骨高位截骨术围术期应用的有效性及安全性。方法 前瞻性分析自2016年2月至2020年4月西安交通大学附属红会医院收治拟行手术且符合本研究纳入标准的54例膝关节骨关节炎患者，其中男13例，女41例；年龄44～65岁，平均(56.9±4.4)岁。按照随机数字表法分为三组，每组各18例。A组：术前30 min静脉点滴1gTXA，关闭切口前1 g TXA深层浸泡5 min；B组：术前30 min和关闭切口前各静脉点滴1 g TXA；C组：关闭切口前静脉点滴1 g TXA，术后3 h、6 h后各静脉追加1 g TXA。记录并比较两组患者的总失血量、隐性失血量、48 h引流量、输血率、纤溶水平、血栓栓塞事件、切口并发症、不良反应、视觉模拟评分(visual analogue scale，VAS)评分、美国特种外科医院(hospital for special surgery，HSS)膝关节评分及生活质量SF-12评分。结果 A组总失血量为(493.56±74.27)mL，B组为(447.44±60.64)mL，C组为(411.36±73.14)mL；A组的隐性失血量为(277.35±47.31)mL，B组为(236.19±35.57)mL，C组为(197.47±50.17)mL；A组的术后48 h引流量为(146.35±37.66)mL，B组为(121.57±35.28)mL，C组为(84.12±26.93)mL；术后第1天血红蛋白均值A组为(112.65±12.23)g/L，B组为(117.51±11.12)g/L，C组为(123.46±10.84)g/L；术后第3天血红蛋白均值A组为(113.17±10.14)g/L，B组为(117.89±9.34)g/L，C组为(124.45±10.42)g/L；术后第1天和第3天VAS疼痛评分对比，B组和C组均低于A组；术后6周和12周SF-12生活质量调查显示，C组的生理健康评分与A组相比差异明显；以上指标组间比较，差异均有统计学意义(P＜0.05)。三组间术后血栓栓塞事件发生率、TXA不良反应及膝关节HSS评分比较，差异均无统计学意义(P＞0.05)。结论 本研究中三种TXA给药方案均安全可靠。术后序贯静脉给药方案可以进一步减少围术期的总失血量、隐性失血量、术后48 h引流量、维持术后血红蛋白水平，并具有减轻疼痛、提高患者生活质量和膝关节功能的优势。
Abstract：Objective To investigate the efficacy of different perioperative tranexamic acid regimens in high tibial osteotomy.Methods 54 patients with knee osteoarthritis who were admitted to honghui hospital affiliated to Xi'an jiaotong university from February 2016 to April 2020 were prospective analyzed，including 13 males and 41 females cases.The patients aged 44 to 65 years，with an average of (56.9±4.4).According to the random number table method，they were divided into three groups，with 18 cases in each group.Group A had intravenous infusion of 1 g TXA 30 min before operation，and deep immersion of 1g TXA for 5 minutes before closing the incision.Group B had intravenous infusion of 1g TXA 30 min before operation and before closing the incision.Group C had intravenous infusion of 1 g TXA before closing the incision，3 hours and 6 hours after operation.1 g TXA was added intravenously again.The total blood loss，hidden blood loss，48-hour drainage，blood transfusion rate，fibrinolysis level，thromboembolic events，incision complications，adverse reactions，VAS score，knee HSS score and quality of life SF-12 score.Results The total blood loss was(493.56±74.27)mL in group A，(447.44±60.64)mL in group B and(411.36±73.14)mL in group C.The hidden blood loss of group A was(277.35±47.31)mL，(236.19±35.57)mL in group B and(197.47±50.17)mL in group C.The drainage volume was(146.35±37.66)mL in group A after 48 hours，(121.57±35.28)mL in group B and(84.12±26.93)mL in group C.The mean hemoglobin value on the first day after surgery was(112.65±12.23)g/L in group A，(117.51±11.12)g/L in group B，and(123.46±10.84)g/L in group C.The average value of hemoglobin at 3 days was(113.17±10.14)g/L in group A，(117.89±9.34)g/L in group B，and(124.45±10.42)g/L in group C.VAS pain score on the 1st and 3rd day after operation of group B and group C were both lower than group A；the SF-12 quality of life survey at 6 and 12 weeks after surgery showed that the body health score(PCS) of group C was significantly different from that of group A.Comparison of the above index groups，the differences were statistically significant(P＞0.05).There was no significant difference in the incidence of postoperative thromboembolic events，TXA adverse events，wound complications and knee HSS scores among the three groups (P＞0.05).Conclusion The three tranexamic acid administration regimens in this study are safe and reliable.Among them，plan C can further reduce perioperative blood loss compared with plan A and plan B，and has the advantages of reducing pain and improving the patient's quality of life and knee joint function.
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