摘要
背景:氨甲环酸在髋膝关节置换中应用广泛,可以减少骨面渗血,近年来该药物在胫骨高位截骨过程中也取得了一定成效,但如何选择使用剂量,评估风险效益暂未可知。目的:评估不同剂量氨甲环酸对胫骨高位截骨后患者失血量的影响。方法:收集2018年3月至2021年7月在四川大学华西医院接受单侧胫骨高位截骨的膝关节内翻畸形患者62例的临床资料,根据氨甲环酸的使用剂量分为3组,低剂量组22例,中剂量组20例,高剂量组20例。氨甲环酸均采用静脉滴注方式给药,低、中剂量组患者于术前30 min接受静脉滴注1 g或2 g氨甲环酸溶液,高剂量组在中剂量组基础上于术后3 h再次给予1 g氨甲环酸。收集并比较3组患者术前和术后血液学指标的差异性;记录并对比3组患者的手术时长、术后输血量、切口并发症及血栓栓塞事件等。结果与结论:①低剂量组与中剂量组手术前后血红蛋白变化和失血量没有显著差异;但高剂量组的血红蛋白丢失量明显少于低剂量组,中、高剂量组的失血量明显少于低剂量组,差异有显著性意义(P<0.05);②3组患者手术前后凝血酶原时间、纤维蛋白原、活化凝血酶原时间的差值相比差异无显著性意义(P>0.05);③3组患者术后均无切口感染和血栓栓塞事件发生,3组并发症方面无明显差异;④提示胫骨高位截骨围术期使用高剂量氨甲环酸可明显减少失血量,且并不增加术后切口并发症及血栓栓塞事件。
BACKGROUND:Tranexamic acid has been widely used in hip and knee replacements,which could reduce blood on the bone surface.In recent years,the drug has also achieved certain results in high tibial osteotomies.However,how to choose the dosage and assess the risk and benefit is not yet known.OBJECTIVE:To evaluate the effect of different doses of tranexamic acid on blood loss after high tibial osteotomy.METHODS:The clinical data of 62 patients with varus knee joint deformity who received unilateral high tibial osteotomy in West China Hospital of Sichuan University from March 2018 to July 2021 were collected.According to different doses of tranexamic acid,the patients were divided into low-dose group of 22 cases,medium-dose group of 20 cases,and high-dose group of 20 cases.Tranexamic acid was administered intravenously.Patients in the low-dose group and medium-dose group received intravenous infusion of 1 g or 2 g tranexamic acid solution 30 minutes before surgery.Patients in the high-dose group received another infusion of 1 g tranexamic acid 3 hours after surgery on the basis of the medium-dose group.The difference of hematological indexes among the three groups before and after surgery was collected and compared.Operation duration,postoperative blood transfusion volume,incision complications,and thromboembolic events were recorded and compared among the three groups.RESULTS AND CONCLUSION:(1)There was no significant difference in hemoglobin changes and blood loss between the low-dose group and the middle-dose group before and after the operation,but the hemoglobin loss of the high-dose group was significantly less than that of the low-dose group.Blood loss was significantly less in the middle-dose and high-dose groups than that of the low-dose group(P<0.05).(2)The differences in prothrombin time,fibrinogen,and activated prothrombin time were not significantly different before and after the operation in patients of the three groups(P>0.05).(3)There were no incision infections or thromboembolic events after the operation in the three groups,and there was no significant difference in complications.(4)It is concluded that perioperative use of high-dose tranexamic acid for high tibial osteotomy can significantly reduce blood loss,and does not increase postoperative incision complications and thromboembolic events.
作者
孙义元
李棋
熊燕
李箭
Sun Yiyuan;Li Qi;Xiong Yan;Li Jian(Day Service Center,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2022年第36期5857-5861,共5页
Chinese Journal of Tissue Engineering Research
关键词
胫骨高位截骨
氨甲环酸
失血量
内翻畸形
切口并发症
血栓栓塞
high tibial osteotomy
tranexamic acid
blood loss
varus deformity
incision complications
thromboembolism
