切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 666 -670. doi: 10.3877/cma.j.issn.1674-134X.2018.05.012

所属专题： 文献；

临床论著

不同氨甲环酸给药途径在全膝关节置换术的有效性和安全性
马瑞1, 杨佩1, 王春生1, 王坤正1,†()   
  1. 1. 710004　西安交通大学第二附属医院骨一科
  • 收稿日期:2018-04-20 出版日期:2018-10-01
  • 通信作者: 王坤正
  • 基金资助:
    国家自然科学基金青年科学基金项目(81702130)

Efficacy and safety of different administration routes of tranexamic acid in total knee arthroplasty

Rui Ma1, Pei Yang1, Chunsheng Wang1, Kunzheng Wang1,†()   

  1. 1. Department of the First Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China
  • Received:2018-04-20 Published:2018-10-01
  • Corresponding author: Kunzheng Wang
  • About author:
    Corresponding author: Wang Kunzheng, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

马瑞, 杨佩, 王春生, 王坤正. 不同氨甲环酸给药途径在全膝关节置换术的有效性和安全性[J]. 中华关节外科杂志(电子版), 2018, 12(05): 666-670.

Rui Ma, Pei Yang, Chunsheng Wang, Kunzheng Wang. Efficacy and safety of different administration routes of tranexamic acid in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(05): 666-670.

目的

探讨氨甲环酸(TXA)不同给药途径(局部、静脉以及局部静脉联合)减少初次膝关节置换术后出血量方面的安全性及有效性。

方法

选取2015年9月至2017年12月在西安交通大学第二附属医院骨一科因重度骨关节炎初次行单侧全膝关节置换术、无TXA使用禁忌的患者共计159例；排除术前存在深静脉血栓DVT、凝血功能异常、术前正使用抗凝药物、术前血红蛋白<100 g/L、伴有恶性肿瘤、伴有或曾发生心肌梗死和脑梗死的患者、伴有出血性疾病者、严重肝肾功能不全者。分为A、B、C、D 4组，A组给予关节腔注射生理盐水100 ml，B组给予关节腔注射氨甲环酸1 g，C组术前30 min给予静脉滴注氨甲环酸1 g，D组术前30 min静脉滴注氨甲环酸1 g ＋关闭关节囊后关节腔注射氨甲环酸1 g。记录患者术后凝血系列、显性失血量，并计算隐性失血量、总失血量、深静脉血栓发生率和输血率。计数资料使用χ2检验，组间相关测量指标比较使用方差分析。

结果

术前、术后1 d、3 d和7 d，同一时间点比较各组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原含量无明显差异。4组术后深静脉血栓的发生率分别为10.53%、11.11%、13.64%和13.51%，差异无统计学意义(χ2＝0.961，P >0.05)。B组、C组和D组的显性失血量、隐性失血量和总失血量都明显低于A组(P <0.05)，D组的显性失血量和总失血量明显低于B组和C组(P <0.05)，而B组和C组的显性失血量、隐性失血量和总失血量均无明显差异(P >0.05)。A、B、C、D 4组的输血率分别为21.05%，6.67%、4.76%和2.94%，B组、C组和D组的输血率明显低于A组(χ2 ＝9.914，P <0.05)。

结论

氨甲环酸局部应用、静脉滴注以及二者联合应用均能有效减少全膝关节置换术后患者的失血量并降低输血率，而不增加术后深静脉血栓的发生率。静脉联合关节腔注射减少术后失血量的效果优于单独使用。

关键词: 氨甲环酸, 关节成形术, 失血，手术, 静脉血栓形成
Objective

To investigate the efficacy and safety of different administration route of tranexamic acid (TXA, topical, intravenous and combined applications) to reduce blood loss of primary total knee arthroplasty (TKA).

Methods

A total of 159 patients undergoing unilateral TKA from September 2015 to December 2017 were randomly divided into four groups. In group A, 100 ml saline was injected into the articular cavity; in group B, 1 g TXA was injected into the articular cavity; in group C, 1g TXA was intravenously given 30 min before the operation; in group D, 1g TXA was intravenously given 30 min before the operation and 1 g TXA was injected into the articular cavity after closing the joint capsule. Clotting series and external blood loss were recorded, and hidden blood loss, total blood loss, incidence of deep vein thrombosis (DVT) and the rate of blood transfusion were calculated. Measurement data was analyzed using one-way ANOVA, and calculator information was analyzed using chi-square test.

Results

The PT, APTT and fibrinogen content before the operation and 1d, 3d and 7d after the operation showed no significant difference among different groups (P >0.05). In group A, B, C and D, the incidence of postoperative DVT were 10.53%, 11.11%, 13.64% and 10.53%, respectively, and no statistical significance was found (χ2=0.961, P >0.05). The external blood loss, hidden blood loss and total blood loss of group B, C and D were significantly lower than those of group A (P<0.05); the external blood loss and total blood loss of group D were lower than those of group B and group C (P<0.05); but the external blood loss, hidden blood loss and total blood loss displayed no obvious difference between group B and group C (P >0.05). In group A, B, C and D, the transfusion rate were 21.05%, 6.67%, 4.76%和2.94% respectively. The transfusion rates of group B, C and D were apparently lower than that of group A (χ2=9.914, P <0.05).

Conclusion

Topical intravenous and combined applications of TXA could all effectively reduce blood loss and decrease the rate of blood transfusion of TKA, showing no increase of the incidence of DVT; while combined application is more effective in reducing blood loss than other methods of drug administration.

Key words: Tranexamic acid, Arthroplasty, Blood loss, surgical, Venous thrombosis
表1 术前各组一般资料对比
组别 例数 性别(男/女) 年龄[岁，(±s)] 身体质量指数[kg/m2 ，(±s)] 手术时间[min，(±s)] 切口长度[cm，(±s)]
A组 38 12/26 70.0±5.7 22.8±2.0 81.3±4.8 14.7±1.4
B组 45 17/28 70.5±6.1 22.8±2.2 82.7±5.2 14.3±1.1
C组 42 14/28 69.6±5.6 23.1±2.4 90.0±4.9 14.7±1.0
D组 34 12/22 70.9±6.1 23.0±2.1 83.6±5.1 14.6±1.2
统计值 ? χ2＝0.391 F＝0.380 F ＝0.234 F ＝0.135 F ＝0.509
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05
表2 术前与术后凝血指标及术后DVT发生率的比较
组别 例数 PT [s，(±s)] APTT [s，(±s)] Fib [mg/L，(±s)] DVT(%)
术前 术后1 d 术后3 d 术后7 d 术前 术后1 d 术后3 d 术后7 d 术前 术后1 d 术后3 d 术后7 d
A组 38 11.8±1.2 11.9±1.0 11.8±1.1 11.7±1.1 27.8±3.5 28.2±3.1 28.2±3.1 27.2±3.4 26.7±5.9 35.0±6.7 39.6±7.5 39.0±8.5 10.53
B组 45 11.6±1.0 11.6±1.0 11.7±1.0 11.3±1.0 28.4±3.2 28.6±2.9 27.8±3.1 27.5±3.0 27.2±6.0 38.2±8.8 38.8±7.8 36.8±8.8 11.11
C组 42 11.6±1.1 11.4±0.9 11.3±1.0 11.2±0.9 27.9±3.8 28.2±3.0 27.4±3.5 27.8±2.2 28.2±4.9 37.1±9.7 38.8±6.4 38.6±8.8 13.64
D组 34 11.6±1.1 11.4±1.1 11.5±1.1 11.3±1.1 29.2±2.5 28.2±3.0 28.6±2.7 27.5±2.4 28.9±5.6 39.7±8.4 39.4±7.4 38.1±9.2 13.51
统计值 ? F ＝0.307 F ＝2.391 F ＝1.831 F ＝2.076 F ＝1.332 F ＝0.183 F ＝0.927 F ＝0.376 F ＝1.140 F ＝1.934 F ＝0.131 F ＝0.514 χ2＝0.961
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
图1 各组术后24 h显性失血量、隐性失血量和总失血量的比较。*－P <0.05，LSD法两两比较，差异有统计学意义
[1]
Hiippala ST, Strid LJ, Wennerstrand MI, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty[J]. Anesth Analg, 1997, 84(4):839-844.
[2]
Risberg B. The response of the fibrinolytic system in trauma[J]. Acta Chir Scand Suppl, 1985, 522:245-271.
[3]
Fahmy NR, Patel DG. Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet[J]. J Bone Joint Surg Am, 1981, 63(3):461-465.
[4]
Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications[J]. Drugs, 1999, 57(6):1005-1032.
[5]
Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis[J]. J Bone Joint Surg Am, 2012, 94(13):1153-1159.
[6]
Jain NP, Nisthane PP, Shah NA. Combined administration of systemic and topical tranexamic acid for total knee arthroplasty: can it be a better regimen and yet safe? A randomized controlled trial[J]. J Arthroplasty, 2016, 31(2):542-547.
[7]
闵令田，翁文杰，邱勇，等．关节腔内灌注氨甲环酸降低全膝关节置换手术出血的前瞻性随机对照研究[J/CD]．中华关节外科杂志(电子版)，2014，8(4):482-486.
[8]
李辉，马建兵，姚舒馨，等．氨甲环酸应用于全膝关节置换术围术期的给药方式比较[J]．中华骨与关节外科杂志，2017，10(1):37-40.
[9]
Wang H, Shen B, Zeng Y. Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: A meta-analysis of randomized controlled and prospective cohort trials[J]. Knee, 2014, 21(6):987-993.
[10]
Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients[J]. Clin Orthop Relat Res, 2012, 470(9):2605-2612.
[11]
Seo JG, Moon YW, Park SH, et al. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8):1869-1874.
[12]
Song EK, Seon JK, Prakash J, et al. Combined administration of IV and topical tranexamic acid is not superior to either individually in primary navigated TKA[J]. J Arthroplasty, 2017, 32(1):37-42.
[13]
Bourke DL, Smith TC. Estimating allowable hemodilution[J]. Anesthesiology, 1974, 41(6):609-612.
[14]
Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in normal human adults[J]. Surgery, 1962, 51(2):224-232.
[15]
Benoni G, Björkman S, Fredin H. Application of pharmacokinetics data from healthy volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients[J]. Clin Drug Investig, 1995, 10(5):280-287.
[16]
Tanaka N, Sakahashi H, Sato E, et al. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee[J]. J Bone Joint Surg Br, 2001, 83(5):702-705.
[17]
Wong J, Abrishami A, El BH, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty：a randomized，controlled trial[J]. J Bone Joint Surg Am, 2010, 92(15):2503-2513.
[18]
Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement[J]. Br J Anaesth, 2003, 90(5):596-599.
[19]
Camarasa GA, Serra－Prat M, Palomera FE. Effectiveness of tranexamic acid in routine performance of total knee replacement surgery[J]. Rev Esp Anestesiol Reanim, 2008, 55(2):75-80.
[20]
徐掭发，詹科，胡俊勇，等．氨甲环酸在首次人工全膝关节置换术围手术期减少出血的研究[J/CD]．中华关节外科杂志(电子版)，2017，11(1):35-40.
[21]
Lin SY, Chen CH, Fu YC, et al. The efficacy of combined use of intraarticular and intravenous tranexamic Acid on reducing blood loss and transfusion rate in total knee arthroplasty[J]. J Arthroplasty, 2015, 30(5):776-780.
[1] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[2] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[3] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[4] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[5] 林文, 王雨萱, 许嘉悦, 王矜群, 王睿娜, 何董源, 樊沛. 人工关节置换登记系统的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 834-841.
[6] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[7] 贺敬龙, 尚宏喜, 郝敏, 谢伟, 高明宏, 孙炜, 刘安庆. 重度类风湿关节炎患者行多关节置换术的临床手术疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 860-864.
[8] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[9] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[10] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[11] 李辉, 吴奇, 张子琦, 张晗, 王仿, 许鹏. 日间全膝关节置换术早期疗效及标准化流程探索[J]. 中华关节外科杂志(电子版), 2023, 17(06): 889-892.
[12] 肖志满, 龚煜, 谢景凌, 刘斌伟. 上下肢关节镜手术后患者下肢深静脉血栓发生的对比研究[J]. 中华关节外科杂志(电子版), 2023, 17(05): 601-606.
[13] 姚轶超, 张麒, 滕海茂, 黄攀, 吴雷涛, 韩哲. 膝关节置换术后恐动症与康复效果及社会支持的相关性[J]. 中华关节外科杂志(电子版), 2023, 17(05): 613-618.
[14] 黄应雄, 叶子, 蒋鹏, 詹红, 姚陈, 崔冀. 急性肠系膜静脉血栓形成致透壁性肠坏死的临床危险因素分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 413-421.
[15] 李岩松, 李涛, 张元鸣飞, 李志鹏, 周谋望. 头戴式虚拟现实设备辅助全膝关节置换术后康复的初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 676-681.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号