CAJ | 학술논문

目的探讨氨甲环酸对全膝关节置换术围手术期失血量的影响及安全性.方法 2008年5月至2009年2月,选取98例拟行全膝关节置换术的患者.男35例,女63例.病因:骨性关节炎66例,类风湿关节炎32例.病程2～12年,平均5年.随机分为A、B两组,每组49例:A组在松止血带时将氨甲环酸1 g稀释于250ml生理盐水后静脉点滴,3 h后以相同剂量再次给药;B组仅给予等量生理盐水静脉点滴.以术中失血量、术后可见失血量、输血量、输血人数、术后血红蛋白和术后纤维蛋白原、凝血酶原时间等为评价指标,对两组进行比较.观察患者术后是否出现下肢深静脉栓塞的临床症状,并于术后14d进行下肢血管多普勒检查.结果术中失血量两组比较差异无统计学意义(P>0.05),但术后可见失血量、输血量、输血人数A组均明显少于B组(P<0.05).术后血红蛋白值,A组明显大于B组(P<0.05).两组患者术中松止血带和术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间的比较差异无统计学意义(P>0.05).术后14d未发现卜肢深静脉血栓形成.结论在全膝关节置换术中及术后短期使用氨甲环酸能明显降低患者失血量及输血量,并且不增加静脉血栓形成的风险.
목적 탐토안갑배산대전슬관절치환술위수술기실혈량적영향급안전성.방법 2008년5월지2009년2월,선취98례의행전슬관절치환술적환자.남35례,녀63례.병인:골성관절염66례,류풍습관절염32례.병정2～12년,평균5년.수궤분위A、B량조,매조49례:A조재송지혈대시장안갑배산1 g희석우250ml생리염수후정맥점적,3 h후이상동제량재차급약;B조부급여등량생리염수정맥점적.이술중실혈량、술후가견실혈량、수혈량、수혈인수、술후혈홍단백화술후섬유단백원、응혈매원시간등위평개지표,대량조진행비교.관찰환자술후시부출현하지심정맥전새적림상증상,병우술후14d진행하지혈관다보륵검사.결과술중실혈량량조비교차이무통계학의의(P>0.05),단술후가견실혈량、수혈량、수혈인수A조균명현소우B조(P<0.05).술후혈홍단백치,A조명현대우B조(P<0.05).량조환자술중송지혈대화술후3 h섬유단백원、응혈매원시간화활화부분응혈활매시간적비교차이무통계학의의(P>0.05).술후14d미발현복지심정맥혈전형성.결론 재전슬관절치환술중급술후단기사용안갑배산능명현강저환자실혈량급수혈량,병차불증가정맥혈전형성적풍험.
Objective To investigate the efficacy and safety of tranexamic aeid on perioperative blood loss associated with total knee arthroplasty(TKA). Methods From May 2008 to February 2009, 98 pa-tients (35 males, 63 females) underwent TKA, 66 cases with osteoarthritis, 32 with rheumatoid arthritis. The course of illness ranged from 2 to 12 years (mean, 5 years). They were randomly divided into Group A and B with 49 patients each. The patients in Group A received tranexamic acid, and the patients in Group B re-ceived an equal volume of normal saline, in Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 h later. In Group B, only 250 ml of normal saline was infused in-travenously. The amounts of intraoperative blood loss, postoperative wound blood loss and blood transfusion,the number of the patients needing blood transfusion and the value of postoperative hemoglobin concentration of all patients were recorded. Fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.And they were also observed for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler uhrasonography 14 days after operation. Results There was no signifi-cant difference in intraoperative blood loss botween two groups(P >0.05). There were significant differences in the amount of postoperative wound blood loss, blood transfusion, the number of the patients needing blood transfusion and the value of postoperative hemoglobin concentration between two groups, Group A were lower than Group B (P< 0.05). The postoperative hemoglobin concentration was higher in Group A than that in Group B (P< 0.05). There were no significant differences in the levels of fibrinogen, prothrumbin time, and activated partial thromboplastin time between two groups (P>0.05). And no deep vein thrombosis was found 14 days after operation. Conclusion During and after the TKA, a short-term use of tranexamic acid can significantly decrease blood loss and blood transfusion without increasing risk for venous thrombosis.