氨甲环酸不同给药方案在胫骨高位截骨围术期应用的疗效评价

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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.

Key words： knee osteoarthritis tranexamic acid blood loss high tibial osteotomy

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