氨甲环酸在全髋关节置换中应用方法的临床研究

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摘要目的比较氨甲环酸(tranexamic acid，TXA)的不同应用方法对初次行全髋关节置换术(total hip arthroplasty，THA)患者控制失血量(显性失血和隐性失血)的有效性及安全性。方法选取2015年11月至2016年11月大连大学附属中山医院初次行全髋关节置换术的患者75例，其中男31例，女44例，年龄50～71岁，平均(61.0±5.5)岁，所有符合纳入标准的患者术前均签署知情同意书并配合临床研究。随机将75例患者分为A、B、C三组，每组25例患者。A组：术前30 min静点1 g氨甲环酸；B组：术前30 min静点1 g氨甲环酸＋术中浸泡1 g氨甲环酸；C组：术前30 min静点1 g氨甲环酸＋术中浸泡1 g氨甲环酸＋术后3 h静点1 g氨甲环酸。记录术中出血量、术后引流量和术前及术后的血红蛋白(hemoglobin Hgb)、红细胞压积(hematocrit，Hct)、手术前后双下肢深静脉彩超结果，观察有无下肢深静脉血栓(deep venous thromosis，DVT)形成，应用SPSS17.0软件进行统计学分析。结果 A组：应用氨甲环酸后，显性失血量为(748.3±80.2)mL，隐性失血量为(273.7±85.0)mL；B组：应用氨甲环酸后，显性失血量为(514.4±67.6)mL，隐性失血量为(193.1±71.0)mL；C组：应用氨甲环酸后，显性失血量为(463.3±67.6)mL，隐性失血量为(168.2±75.0)mL。B、C两组患者应用氨甲环酸后均比A组方法应用氨甲环酸能明显减少初次全髋关节置换术的显性出血量和隐性出血量(P＜0.05)，差异有统计学意义；但B、C两组对比显性失血量和隐性失血量差异无统计学意义(P＞0.05)。而按照A、B、C三组方法应用氨甲环酸后，所有患者均未发生双下肢深静脉血栓。结论按照B、C两组方法应用氨甲环酸比A组方法应用能明显减少初次全髋关节置换中的围手术期失血量，且三组方法均未造成下肢深静脉血栓及肺栓塞发生，作用安全有效；但是B、C两组应用方法相比较差异无统计学意义，建议全髋关节置换术按照术前静点1g氨甲环酸＋术中浸泡1g氨甲环酸此种方法应用。

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关键词 ：氨甲环酸, 全髋关节置换, 显性失血量, 隐性失血量, 深静脉血栓

Abstract：Objective To compare different application methods of the tranexamic acid (TXA) in the treatment of primary total hip arthroplasty (THA) and evaluate the efficacy and safety of patients with blood loss (both dominant blood loss and hidden blood loss).Methods From November 2015 to November 2016，75 cases of patients in the Zhongshan hospital of Dalian university in the treatment of total hip replacement，including 31 cases of male，44 cases of female，average age 61.0±5.5(50～71 years old)，all patients who meet the inclusion criteria，and sign preoperative informed consent and cooperate with clinical research.75 patients were randomly divided into A，B，C，group of four patients in each group (n＝25).Group A：1g tranexamic acid was given intravenously 30 minutes before surgery intravenous.Group B：30 minutes before surgery 1g tranexamic acid was given intravenously and 1 g tranexamic acid was given during operation.Group C：30 minutes before surgery 1 g tranexamic acid was given intravenously ＋1 g tranexamic acid was given during operation＋1 g tranexamic acid was given intravenously 3 hours after surgery.We recorded the amount of hemoglobin，postoperative drainage and preoperative and postoperative bleeding (Hgb) and hematocrit (Hct)，meanwhile examined lower extremity deep venous color Doppler ultrasound both preoperatively and postoperatively，observing whether the deep venous thrombosis of lower extremity (DVT) were formed.SPSS17.0 software were used for statistical analysis of the results.Results Group A：Dominant blood loss was (748.3±80.2)mL，hidden blood loss was (273.7±85.0)mL；group B：Dominant blood loss was (514.4±67.6)mL，hidden blood loss was (193.1±71.0)mL；group C：Dominant blood loss was (463.3±67.6)mL，hidden blood loss (168.2±75.0)mL.Three different method way of ammonia tranexamic acid group applied in B，C gruop were sharply decreased compare with group A，indicating dominant blood loss and hidden blood loss was both dropped in the treatment of primary total hip arthroplasty (P＜0.05)，the difference was statistically significant；but between group B and C，the dominant blood loss and hidden blood loss had no significant difference (P＞0.05).And according to the application of ammonia method in all three groups，tranexamic acid，lower extremity deep venous thrombosis and pulmonary embolism was not seen in all patients，indicating this drug is safe and effective.Conclusion Compare with group A，both group B and Ccan significantly reduce perioperative blood loss in the primary total hip arthroplasty，and does not cause deep venous thrombosis and pulmonary embolism，these treatments are safe and effective role；but B and C comparison has no statistically significant，so 1 g tranexamic acid given intravenously 30 minutes before surgery plus 1 g tranexamic acid given during operation is recommended in the application of ammonia tranexamic acid for total hip replacement.

Key words： tranexamic acid total hip arthroplasty dominant blood loss hidden blood loss deep vein thrombosis

通讯作者: 赵德伟

作者简介: 刘峰(1987－ )，男，研究生在读，遵义医学院研究生院，563003。

引用本文:

刘峰 1，2,刘保一 2，赵德伟 2*. 氨甲环酸在全髋关节置换中应用方法的临床研究[J]. 实用骨科杂志, 2017, 23(12): 1086-1094.
Liu Feng 1，2 Liu Baoyi 2，Zhao Dewei 2. Clinical Application of Tranexamic Acid in Total Hip Arthroplasty. sygkzz, 2017, 23(12): 1086-1094.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I12/1086

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