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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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

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［1］苗兵.毕晓扬.任凯晶.等.氨甲环酸对全膝关节置换术围手术期失血量的影响及安全性评估［J］.中华骨科杂志，2009，29(9)：864-867.
［2］Theusinger OM，Kind SL，Seifert B，et al.Patient blood management in orthopaedicsurgery：a four-year follow up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich，Awitzerland ［J］.Blood Transfus，2014，12(2)：195-203.
［3］Mccormack PL.Tranexamic acid：a review of its use in the treatment of hyperfibrinolysis［J］.Drugs，2012，72(5)：585-617.
［4］Taparia M，Cordingley FT，Leahy MF.Pulmonary embolism associated with tranexamic acid in severe acquired haemophilia ［J］..Eur J Haematol，2002，68(5)：307-309.
［5］Krivokuca I，Lammers JW.Recurrent pulmonary embolism associated with a hemostatic drug［J］.Clin Appl Thromb Hemost，2011，17(1)：106-107.
［6］BruceBrand R，Dragomir R，Baker J，et al Cerebrovascular infarction following bilateral total knee arthroplasty and tranexamic acid administration［J］.Acta Orthop Belg，2013，79(3)：351-354.
［7］Gross JB.Estimating allowable blood loss：corrected for dilution［J］.Anesthesiolog，1983，58(3)：277-280.
［8］Nadler SB，Hidalgo JU，Bloch T.Prediction of blood volume in normal human adults［J］.Surgery，1962，51(2)：224-232.
［9］Panteli M，Papakostidis C，Dahabreh Z，et al.Topical tranexamic acid in total knee replacement：A systematic review and meta-analysis［J］.Knee，2013，20(5)：300-309.
［10］Eubanks JD.Antifibrinolytics in major orthopaedic surgery［J］.J Am Acad Orthop Surg，2010，18(3)：132-138.
［11］Niskanen RO Korkala OL.Tranexamic acid reduces bloodloss in cemented hip arthroplasty：a randomized，double-blind study of 39 patients with osteoarthritis［J］.ActaOr-thop，2005，76(6)：829-832.
［12］Zufferey P，Merquiol F，Laporte S，et al.Do antifibrionlytics reduce allogeneic blood transfusion in orthopedic surgery ［J］.Thromb Res，2009，123(5)：687-696.
［13］傅峥，张健.氨甲环酸使用时间与全髋关节置换术隐性失血的临床研究［J］.中华创伤杂志，2013，29(6)：541-544.
［14］张弛，乔志，刘宏健，等.术前单一剂量氨甲环酸对初次全髋关节置换术围手术期失血的影响及安全性评估［J］.中华实验外科杂志，2014，31(4)：900-902.
［15］Alshryda S，Mason J，Vaghela M，et al.Topical (intraarticular) tranexamic arid reduces blood loss and transfusion rates following total knee replacement：a randomized controlled trial (TRANX-K) ［J］.J Bone Joint Surg Am，2013，21(12)：1961-1968.
［16］马云青，张轶超，张洪.氨甲环酸在单侧全膝关节置换术中局部应用的止血效果分析［J］.中华外科杂志，2013，51(1)：40-43.
［17］Yue C，Kang P，Yang P，et al.Topical application of tranexamic acid in primary total hip arthroplasty：arandomized doubleblind controlled trial［J］.J Arthroplasty，2014，29(12)：2452-2456.
［18］Katsumata S，Nagashima M，Kato K，et al.Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism［J］.ActaAnaesthesiol Scand.2005，49(4)：510-516.
［19］Benoni G，Lethagen S，Nilsson P，et al.Tranexamic acid，given at the end of the operation，does not reduce postoperatⅡve blood loss in hip arthroplasty［J］.Acta Orthop Scand，2000，71(3)：250-254.
［20］Patel VP，Walsh M，Sehgal B，et al.Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty［J］.J Bone Joint Surg (Am)，2007，89(1)：33-38.
［21］Rajesparan K，Biant LC，Ahmad M，et al.The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement［J］.J Bone Joint Surg (Br)，2009，91(6)：776.
［22］Faris PM，Ritter MA，Keating EM，et al.Unwashed filtered shed blood collected after knee and hip arthroplasties.A source of autologous red blood cells［J］.J Bone Joint Surg(Am)，1991，73(8)：1169-1178.
［23］王剑，谢飞，刘先齐，等.氨甲环酸的使用方式对全髋置换术显性隐性失血影响的研究［J］.重庆医学，2015，44(8)：1063-1066.
［24］Lin ZX，Woolf SK.Safety，Efficacy，and cost-effectiveness of tranexamic acid in orthopedic surgery［J］.Orthopedics，2016，39(2)：119-130.
［25］Kim C，Park SS，Davey JR，et al.Tranexamic acid for the prevention and management of orthopedic surgical hemorrhage：current evidence［J］.J Blood Med，2015，6(1)：239-244.