两种止血药在全髋关节置换术围手术期的应用

doi:10.3877/ cma.j.issn.1674-134X.2025.01.002

目的

对比分析氨甲环酸（TXA）与TXA联合流体明胶在全髋关节置换术（THA）中的安全性和有效性。

方法

选取2021年1月至2022年12月在绵阳市第三人民医院收治的股骨颈骨折患者245例。纳入标准：单侧股骨颈骨折行全髋关节置换术患者；排除标准：血液系统疾病或其他影响凝血功能疾病、既往髋部手术史、对氨甲环酸或流体明胶原材料猪皮过敏。根据患者是否合并使用流体明胶分为氨甲环酸组130例，流体明胶组115例，比较两组患者围手术期失血量、术前1天、术后第1天及第3天的血常规、D二聚体等，两组之间比较采用独立样本t检验，两组患者的多个时间点血常规、D二聚体的变化采用重复测量方差分析。

结果

流体明胶组术后第3天血红蛋白、红细胞比容水平高于氨甲环酸组，两组间比较差异有统计学意义（血红蛋白：t=5.54，P<0.001；红细胞比容：t=5.65，P<0.001）；流体明胶组术后第3天血红蛋白下降率、红细胞比容下降率低于氨甲环酸组差异有统计学意义（血红蛋白下降率：t=4.37，P<0.001；红细胞比容下降率：t=636，P<0.001）。总失血量流体明胶组（543.8±252.9）ml比氨甲环酸组（797.1±357.5）ml少，隐性失血量流体明胶组（490.5±252.3）ml比氨甲环酸组（742.8±353.3）ml减少，两组间比较差异有统计学意义（t=6.32、6.35，均为P<0.001））。流体明胶组输血率2.6%，氨甲环酸组输血率9.2%，组间比较差异有统计学意义(χ²=3.88, P=0.04)。两组患者术后深静脉血栓发生率差异无统计学意义（P>0.05）。

结论

TXA 与流体明胶联合使用较单独使用TXA能有效减少围术期的出血量，减少术后输血需求，同时不增加患者患者术后深静脉血栓发生率。

关键词: 氨甲环酸, 关节成形术,置换,髋, 止血药

Objective

To comparative analyze the safety and efficacy of tranexamic acid (TXA) alone versus TXA combined with fluid gelatin in total hip arthroplasty (THA).

Methods

A total of 245 patients with femoral neck fractures, admitted to the Third Hospital of Mianyang from January 2021 to December 2022, were included in this study.Inclusion criteria: patients with unilateral femoral neck fractures who underwent total hip arthroplasty.Exclusion criteria: hematological diseases or other conditions affecting coagulation function, history of hip surgery, or allergies to tranexamic acid or the raw materials of fluid gelatin (derived from pig skin).The patients were divided into two groups: the tranexamic acid group with 130 cases and the fluid gelatin group with 115 cases, based on whether they received co-administration with fluid gelatin.The perioperative blood loss,blood routine, and D-dimer levels were compared between the two groups on the day before surgery, the first day after surgery, and the third day after surgery.Independent sample t test was employed for comparisons between the two groups, while repeated measures ANOVA was performed to analyze changes in complete blood count and D-dimer levels at multiple time points in both groups.

Results

On the third day after surgery, the hemoglobin and hematocrit levels in the fluid gelatin group were significantly higher than those in the TXA group (hemoglobin:t=5.54, P<0.001; hematocrit: t=5.65, P<0.001).The rates of hemoglobin and hematocrit decreases in the fluid gelatin group were lower compared to the TXA group, with statistically significant differences (hemoglobin decrease rate: t=4.37, P<0.001; hematocrit decrease rate: t=6.36, P<0.001).The total blood loss in the fluid gelatin group (543.8±252.9) ml was less than (797.1±357.5) ml in the TXA group.The hidden blood loss in the fluid gelatin group (490.5±252.3) ml was lower than (742.8±353.3) ml in the tranexamic acid group,with statistically significant differences (t=6.32, t=6.35, P<0.001).The blood transfusion rate in the fluid gelatin group was 2.6%, and the rate in the tranexamic acid group was 9.2%, showing statistically significant difference (χ²=3.88, P=0.04).There was no statistically significant difference in the incidence of postoperative deep vein thrombosis between the two groups (P>0.05).

Conclusion

The combined use of TXA and fluid gelatin can effectively reduce perioperative bleeding and decrease the need for postoperative blood transfusions compared to the use of TXA alone, without increasing the incidence of postoperative deep vein thrombosis in patients.

Key words: Tranexamic acid, Arthroplasty, replacement, hip, Hemostatics

表1 一般资料比较

Table 1 Comparison of general data

组别Groups	例数Number of cases	性别（例） Gender		年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	部位（例）Side
组别Groups	例数Number of cases	男 Male	女 Female	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	左 Left	右Right
流体明胶组Fluid gelatin group	115	58	57	70±14	23±4	68	47
氨甲环酸组TXA group	130	67	63	70±14	23±3	71	59
统计值Statistical values		χ ²=0. 03		t=0. 08	t=0. 86	χ ²=0. 51
P值		>0. 05		>0. 05	>0. 05	>0. 05

表1 一般资料比较

Table 1 Comparison of general data

组别Groups	例数Number of cases	性别（例） Gender		年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	部位（例）Side
组别Groups	例数Number of cases	男 Male	女 Female	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	左 Left	右Right
流体明胶组Fluid gelatin group	115	58	57	70±14	23±4	68	47
氨甲环酸组TXA group	130	67	63	70±14	23±3	71	59
统计值Statistical values		χ ²=0. 03		t=0. 08	t=0. 86	χ ²=0. 51
P值		>0. 05		>0. 05	>0. 05	>0. 05

表2 两组围手术期间血红蛋白变化（±s）

Table 2 Perioperative hemoglobin changes of the two groups

组别Groups	例数Number of cases	术前1 d（g/L）One day before surgery	术后第1天（g/L）First day after surgery	术后第3天（g/L）Third day after surgery	术后第3天下降率(%)Decline rate on third day after surgery
流体明胶组Fluid gelatin group	115	124±16	110±15^a	108±13^ab	12±7
氨甲环酸组TXA group	130	122±16	106±16^a	98±13^ac	19±12
t 值		0. 94	1. 81	5. 54	4. 37
P值		>0. 05	>0. 05	＜0. 001	＜0. 001

表2 两组围手术期间血红蛋白变化（±s）

Table 2 Perioperative hemoglobin changes of the two groups

组别Groups	例数Number of cases	术前1 d（g/L）One day before surgery	术后第1天（g/L）First day after surgery	术后第3天（g/L）Third day after surgery	术后第3天下降率(%)Decline rate on third day after surgery
流体明胶组Fluid gelatin group	115	124±16	110±15^a	108±13^ab	12±7
氨甲环酸组TXA group	130	122±16	106±16^a	98±13^ac	19±12
t 值		0. 94	1. 81	5. 54	4. 37
P值		>0. 05	>0. 05	＜0. 001	＜0. 001

表3 两组围手术期间红细胞比容变化（±s）

Table 3 Perioperative hematocrit changes of the two groups

组别Groups	例数Number of cases	术前1 dOne day before surgery	术后第1天First day after surgery	术后第3天Third day after surgery	术后第3天下降率(%)Decline rate on third day after surgery
流体明胶组Fluid gelatin group	115	37±4	33±4^a	32±3^a	14±7
氨甲环酸组TXA group	130	37±4	32±4^a	29±4^ab	20±8
t 值		0. 47	1. 51	5. 65	6. 36
P值		>0. 05	>0. 05	＜0. 001	＜0. 001

表3 两组围手术期间红细胞比容变化（±s）

Table 3 Perioperative hematocrit changes of the two groups

组别Groups	例数Number of cases	术前1 dOne day before surgery	术后第1天First day after surgery	术后第3天Third day after surgery	术后第3天下降率(%)Decline rate on third day after surgery
流体明胶组Fluid gelatin group	115	37±4	33±4^a	32±3^a	14±7
氨甲环酸组TXA group	130	37±4	32±4^a	29±4^ab	20±8
t 值		0. 47	1. 51	5. 65	6. 36
P值		>0. 05	>0. 05	＜0. 001	＜0. 001

表4 两组失血量及输血率

Table 4 Blood loss and transfusion rates in two groups

组别Groups	例数Number of cases	TBL ［ml，（x±s）］	HBL ［ml，（x±s）］	输血率［例（%）］ Blood transfusion rate
流体明胶组Fluid gelatin group	115	543. 8±252. 9	490. 5±252. 3	3/112（2. 6）
氨甲环酸组TXA group	130	797. 1±357. 5	742. 8±353. 3	11/119（9. 2）
统计值Statistical values		t=6. 32	t=6. 35	χ ²=3. 88
P值		＜0. 001	＜0. 001	0. 04

表4 两组失血量及输血率

Table 4 Blood loss and transfusion rates in two groups

组别Groups	例数Number of cases	TBL ［ml，（x±s）］	HBL ［ml，（x±s）］	输血率［例（%）］ Blood transfusion rate
流体明胶组Fluid gelatin group	115	543. 8±252. 9	490. 5±252. 3	3/112（2. 6）
氨甲环酸组TXA group	130	797. 1±357. 5	742. 8±353. 3	11/119（9. 2）
统计值Statistical values		t=6. 32	t=6. 35	χ ²=3. 88
P值		＜0. 001	＜0. 001	0. 04

表5 两组患者围手术期间D二聚体比较［mg/L，（±s）］

Table 5 Perioperative D-dimer comparison between two groups

组别Groups	例数Number of cases	术前1 dOne day before surgery	术后第1天First day after surgery	术后第3天Third day after surgery
流体明胶组Fluid gelatin group	115	10. 4±4. 3	4. 1±4. 0^a	2. 5±2. 0^ab
氨甲环酸组TXA group	130	10. 6±18. 1	4. 7±4. 7^a	3. 0±3. 0^ab
t 值		0. 09	1. 02	1. 15
P值		>0. 05	>0. 05	>0. 05

表5 两组患者围手术期间D二聚体比较［mg/L，（±s）］

Table 5 Perioperative D-dimer comparison between two groups

组别Groups	例数Number of cases	术前1 dOne day before surgery	术后第1天First day after surgery	术后第3天Third day after surgery
流体明胶组Fluid gelatin group	115	10. 4±4. 3	4. 1±4. 0^a	2. 5±2. 0^ab
氨甲环酸组TXA group	130	10. 6±18. 1	4. 7±4. 7^a	3. 0±3. 0^ab
t 值		0. 09	1. 02	1. 15
P值		>0. 05	>0. 05	>0. 05

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Perioperative application of two hemostatic agents in total hip arthroplasty

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Perioperative application of two hemostatic agents in total hip arthroplasty