不同时间段静滴氨甲环酸对膝关节置换术后失血量的影响(1)
摘要：目的 探討膝关节置换不同时间点静滴氨甲环酸对患者围手术期出血及术后静脉血栓栓塞(VTE)发生的影响。方法 选取2016年2月～2018年2月于我院行膝关节置换的患者200例，随机分为A、B、C、D四组，各50例。A组在术前及松止血带前静滴氨甲环酸氯化钠注射液各50 ml，B组在术前静滴100 ml，C组在松止血带前静滴100 ml;D组在术前静滴等量氯化钠注射液。记录各组术后24 h引流量、总引流量及输血率;比较各组术后6、24、48 h血红蛋白(Hb)水平及术后24 h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体水平和VTE发生率。结果 A、B、C组术后24 h引流量、总引流量及输血率均少于D组，且A组术后24 h引流量、总引流量及输血率最少，差异有统计学意义(P<0.05);A组术后6、24、48 hHb水平均高于B、C、D组，且B、C组高于D组，差异有统计学意义(P<0.05);D组术后D-二聚体高于A、B、C组，差异有统计学意义(P<0.05)，A、B、C三组比较，差异无统计学意义(P>0.05);术后24 h四组PT、APTT、FIB比较，差异无统计学意义(P>0.05);四组均未出现VTE，术后2周下肢彩超未见血栓形成。结论 氨甲环酸可减少膝关节置换术后出血和输血率，且不增加VTE的发生几率，其中术前与松止血带前静滴氨甲环酸效果最佳，可降低术后引流量，改善患者血红蛋白水平。
关键词：氨甲环酸;全膝关节置换术;静脉血栓
中图分类号：R687.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.24.025
文章编号：1006-1959(2019)24-0078-04
Effects of Intravenous Drip of Tranexamic Acid at Different Time Periods
on Blood Loss after Knee Replacement
SHI Ling
(Department of Joint Surgery，Daping Hospital，the Third Military Medical University，Chongqing 400042，China)
Abstract：Objective To investigate the effects of intravenous drip of tranexamic acid at different time points of knee replacement on patients' perioperative bleeding and postoperative venous thromboembolism (VTE). Methods A total of 200 patients who underwent knee arthroplasty in our hospital from February 2016 to February 2018 were randomly divided into four groups： A， B， C， and D， each with 50 patients. Group A was given 50 ml of tranexamic acid sodium chloride injection before surgery and before the tourniquet. Group B was given 100 ml before surgery. Group C was given 100 ml before the tourniquet. In group D， an equal amount of sodium chloride injection was given intravenously before surgery. Record the 24h postoperative drainage volume， total drainage volume， and transfusion rate of each group; Compare hemoglobin (Hb) levels at 6， 24， and 48 h after surgery and at 24 h postoperatively， prothrombin time (PT)， activated partial thromboplastin time (APTT)， fibrinogen (FIB)， D-dimer levels and VTE incidence.Results The drainage volume， total drainage volume， and blood transfusion rate at 24 h postoperatively were lower in group A， B， and C than in group D， and the drainage volume， total drainage volume， and blood transfusion rate at 24 h postoperative period were the least in group A，the differences were statistically significant (P<0.05); The levels of Hb at 6， 24， and 48 h after operation in group A were higher than those in groups B， C， and D， and those in groups B and C were higher than those in group D，the difference was statistically significant (P<0.05);The D-dimer in group D was higher than that in groups A， B， and C after surgery，the difference was statistically significant (P<0.05). There was no statistically significant difference between the three groups A， B， and C (P>0.05);There was no significant difference in PT， APTT， and FIB between the four groups at 24 h postoperatively (P>0.05); no VTE occurred in the four groups， and no thrombosis was seen in the lower extremity color Doppler ultrasound 2 weeks after the operation. Conclusion Tranexamic acid can reduce the rate of bleeding and blood transfusion after knee replacement without increasing the incidence of VTE. Among them， intravenous tranexamic acid has the best effect before operation and before loosening the tourniquet. It can reduce postoperative drainage. Improve patient hemoglobin levels., 百拇医药(石岭)
关键词：氨甲环酸;全膝关节置换术;静脉血栓
中图分类号：R687.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.24.025
文章编号：1006-1959(2019)24-0078-04
Effects of Intravenous Drip of Tranexamic Acid at Different Time Periods
on Blood Loss after Knee Replacement
SHI Ling
(Department of Joint Surgery，Daping Hospital，the Third Military Medical University，Chongqing 400042，China)
Abstract：Objective To investigate the effects of intravenous drip of tranexamic acid at different time points of knee replacement on patients' perioperative bleeding and postoperative venous thromboembolism (VTE). Methods A total of 200 patients who underwent knee arthroplasty in our hospital from February 2016 to February 2018 were randomly divided into four groups： A， B， C， and D， each with 50 patients. Group A was given 50 ml of tranexamic acid sodium chloride injection before surgery and before the tourniquet. Group B was given 100 ml before surgery. Group C was given 100 ml before the tourniquet. In group D， an equal amount of sodium chloride injection was given intravenously before surgery. Record the 24h postoperative drainage volume， total drainage volume， and transfusion rate of each group; Compare hemoglobin (Hb) levels at 6， 24， and 48 h after surgery and at 24 h postoperatively， prothrombin time (PT)， activated partial thromboplastin time (APTT)， fibrinogen (FIB)， D-dimer levels and VTE incidence.Results The drainage volume， total drainage volume， and blood transfusion rate at 24 h postoperatively were lower in group A， B， and C than in group D， and the drainage volume， total drainage volume， and blood transfusion rate at 24 h postoperative period were the least in group A，the differences were statistically significant (P<0.05); The levels of Hb at 6， 24， and 48 h after operation in group A were higher than those in groups B， C， and D， and those in groups B and C were higher than those in group D，the difference was statistically significant (P<0.05);The D-dimer in group D was higher than that in groups A， B， and C after surgery，the difference was statistically significant (P<0.05). There was no statistically significant difference between the three groups A， B， and C (P>0.05);There was no significant difference in PT， APTT， and FIB between the four groups at 24 h postoperatively (P>0.05); no VTE occurred in the four groups， and no thrombosis was seen in the lower extremity color Doppler ultrasound 2 weeks after the operation. Conclusion Tranexamic acid can reduce the rate of bleeding and blood transfusion after knee replacement without increasing the incidence of VTE. Among them， intravenous tranexamic acid has the best effect before operation and before loosening the tourniquet. It can reduce postoperative drainage. Improve patient hemoglobin levels., 百拇医药(石岭)