摘要
背景背景:静脉和局部氨甲环酸(TXA)在全髋关节置换术(THA)中应用安全有效,已被大多数骨科医师所肯定,但目前静脉联合局部TXA于THA中的应用效果尚不明确。目的:探讨静脉联合局部应用氨甲环酸(TXA)减少初次全髋关节置换术(THA)围术期失血的有效性及安全性。方法方法:2013年9月至2014年11月行THA患者731例,按TXA的不同用法分为3组:静脉TXA组238例,于手术切皮前完成静脉单次15 mg/kg TXA;局部TXA组136例,于术中3个时点使用总量3 g的TXA;静脉联合局部TXA组357例,于术前使用15 mg/kg TXA,并于术中3个时点使用总量1.5 g的TXA。主要观察指标为总失血量、输血率、术后深静脉血栓形成(DVT)及肺栓塞(PE)发生率;次要观察指标为术后引流量、血红蛋白(Hb)下降最大值及伤口并发症发生率。结果结果:静脉联合局部TXA组平均总失血量(819.82±202.82)ml,输血率为1.4%,术后引流量(181.20±37.62)ml,Hb下降最大值(2.95±0.78)g/dl,均明显低于静脉TXA组和局部TXA组,而DVT及症状性PE的发生风险组间比较无统计学差异。静脉TXA组的总失血量、输血率均略低于局部TXA组,两组比较无统计学差异。结论结论:1静脉15 mg/kg TXA、局部3 g TXA及静脉15 mg/kg联合局部1.5 g TXA均可有效减少THA失血量和输血率,不增加DVT的发生风险;2静脉15 mg/kg联合局部1.5 g TXA的效果明显优于静脉15 mg/kg TXA或局部3 g TXA,推荐使用;3静脉15 mg/kg TXA的效果略优于局部3 g TXA。
Background： It is proven that intravenous and topical tranexamic acid（TXA） is safe and effective in total hip arthroplasty（THA）. However, the clinical outcome of combined application of intravenous and topical TXA during THA is still not clear.Objective： To explore the efficacy and safety of intravenous injection combined with topical TXA in reducing perioperative blood loss in primary unilateral THA.Methods： A total of 731 patients undergoing THA between September 2013 and November 2014 were divided into three groups. Intravenous group： 15 mg/kg TXA was intravenously given before THA in 238 patients. Topical group： a total of 3 g TXA was given during the operation at three time points in 136 patients. Combined group： 15 mg/kg TXA was intravenously given before THA and 1.5 g TXA was given during THA in 357 patients. Total blood loss, transfusion, deep vein thrombosis（DVT） and pulmonary embolism（PE） events, postoperative draining, the maximum hemoglobin（HB） drop and other complications were recorded.Results： In the combined group, total blood loss was（819.82±202.82） ml, transfusion rate was 1.4%, postoperative draining was（181.20±37.62） ml and the maximum HB drop was（2.95±0.78） g/dl, which were significantly lower than those in the other two groups. However, there was no significant difference in the incidence of DVT or PE between groups. The transfusion rate and total blood loss in intravenous group were slightly lower than those in topical group, but no significant differences were found.Conclusions： The three above-mentioned TXA application are all effective in reducing blood loss without increasing the risk of DVT and PE during THA. Intravenous injection（15 mg/kg TXA） combined with topical application（1.5 g TXA） is supe-rior to the other two methods and strongly recommended. Meanwhile, the effect of 15 mg/kg intravenous TXA is better than1.5 g topical TXA in reducing total blood loss and transfusions.
出处
《中国骨与关节外科》
2015年第1期44-48,共5页
Chinese Journal of Bone and Joint Surgery
基金
国家卫计委2013年度卫生行业科研专项(2013020007)
关键词
氨甲环酸
全髋关节置换术
静脉联合局部
输血率
深静脉血栓
Tranexamic acid
Total hip arthroplasty
Intravenous injection combined with topical use
Transfusion
Deep vein thrombosis
