氨甲环酸给药时间与TKA围手术期失血量的临床研究

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Abstract Objective To compare the clinical efficacy of intravenous tranexamic acid to reduce perioperative blood loss and transfusion rate in total knee arthroplasty at different dosage time.Methods From January 2017 to December 2017，a total of 168 patients (45 males，123 females) who were planned to undergo primary unilateral TKA.The average age of the patients was 70.5 years old ranging from 60 to 77 years.The diagnoses of the patients were osteoarthritis. All the cases were randomly divided into groups A，B，C and D(42 cases in each group) according to dosage time of tranexamic acid intravenous administration.The patients in groups A，B，and C received tranexamic acid (20 mg/kg，tranexamic acid was dissolved in 250 mL of normal saline) 20 mins before tourniquet inflation，before tourniquet deflation or after tourniquet deflation respectively.The patients in groups D received an equa1 volume of normal saline.Total blood loss (intraoperative and postoperative blood loss)，Hemoglobin losses，blood transfusion volume and blood transfusion rate of all patients were measured and analyzed.Fibrinogen(FIB)，prothrombin time(PT) and activated partial thromboplastin time(APTT) were also examined.And they were also observed for whether they had deep vein thrombosis(DVT) and both lower limbs of all patients were examined by the color Doppler uhrasonography 7 days after operation.Results Total blood loss，hemoglobin losses，blood transfusion volume and blood transfusion rate in group A was lower than those in group B，C，D(P＜0.05)，and in group B.C was lower than those in group D(P＜0.05).However，such differences were not detected between groups B and C(P＞0.05).There were no significant differences in the levels of fibrinogen，prothrombin time，and activated partial thromboplastin time between four groups (P＞0.05)，and no significant difference was detected in the incidence of venous thrombosis(P＞0.05).Conclusion Tranexamic acid reduces perioperative blood loss，hemoglobin losses and transfusion rate in TKA significantly.While Intravenous administration of tranexamic acid before tourniquet inflation is superior than before tourniquet deflation or after tourniquet deflation.

Key words： arthroplasty replacement knee tranexamic acid intravenous administration blood loss surgical

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