CAJ | 학술논문

目的：观察氨甲环酸对初次同期行双侧全膝关节置换术（TKA）患者围手术期失血的有效性及安全性。方法选取在新疆医科大学第一附属医院关节外科2013年4月-2014年4月同期行双侧 TKA 的206例患者。随机分为两组，试验组103例、对照组103例，试验组在第2条膝关节 TKA 术毕松止血带之前将氨甲环酸1 g稀释于250 mL 生理盐水后静点完毕；对照组在相同时间将250 mL 生理盐水静点完毕。比较两组围手术期失血量、输血量及并发症情况。结果试验组和对照组术中出血量、术中输血量差异无统计学意义（P ＞0．05）；两组术后输血量分别为（117．48±214．40）mL 和（357．38±325．08）mL，差异有统计学意义（P ＜0．05）。围手术期总失血量分别为（1628．10±570．32）mL 和（2120．11±529．20）mL，差异有统计学意义（P ＜0．05）。试验组出现皮下瘀斑患者41例（39．81％），对照组76例（73．79％），两组差异有统计学意义（χ2＝22．87，P ＜0．001）。两组术前、术后3 h凝血功能比较差异无统计学意义（P ＞0．05）。两组患者术后第5天及术后1个月复查双下肢血管 B 超，未见深静脉血栓（DVT）形成。结论初次同期行双侧 TKA 手术中于第2条膝关节 TKA 术毕松止血带之前静脉给予TXA 能明显减少围手术期失血量及输血量，降低输血风险及输血费用，明显减少双下肢瘀斑发生率及瘀斑面积，利于术后功能恢复，且不增加下肢深静脉血栓（DVT）形成及肺栓塞（PE）的风险。
목적：관찰안갑배산대초차동기행쌍측전슬관절치환술（TKA）환자위수술기실혈적유효성급안전성。방법선취재신강의과대학제일부속의원관절외과2013년4월-2014년4월동기행쌍측 TKA 적206례환자。수궤분위량조，시험조103례、대조조103례，시험조재제2조슬관절 TKA 술필송지혈대지전장안갑배산1 g희석우250 mL 생리염수후정점완필；대조조재상동시간장250 mL 생리염수정점완필。비교량조위수술기실혈량、수혈량급병발증정황。결과시험조화대조조술중출혈량、술중수혈량차이무통계학의의（P ＞0．05）；량조술후수혈량분별위（117．48±214．40）mL 화（357．38±325．08）mL，차이유통계학의의（P ＜0．05）。위수술기총실혈량분별위（1628．10±570．32）mL 화（2120．11±529．20）mL，차이유통계학의의（P ＜0．05）。시험조출현피하어반환자41례（39．81％），대조조76례（73．79％），량조차이유통계학의의（χ2＝22．87，P ＜0．001）。량조술전、술후3 h응혈공능비교차이무통계학의의（P ＞0．05）。량조환자술후제5천급술후1개월복사쌍하지혈관 B 초，미견심정맥혈전（DVT）형성。결론초차동기행쌍측 TKA 수술중우제2조슬관절 TKA 술필송지혈대지전정맥급여TXA 능명현감소위수술기실혈량급수혈량，강저수혈풍험급수혈비용，명현감소쌍하지어반발생솔급어반면적，리우술후공능회복，차불증가하지심정맥혈전（DVT）형성급폐전새（PE）적풍험。
Objective To investigate the efficacy and safety of tranexamic acid in treating perioperative blood loss in patients who received bilateral TKA.Methods From April 2013 to April 2014,206 patients from Joint Surgery of The First Affiliated Hospital of Xinjiang Medical University underwent primary bi-lateral TKA and they were randomly divided into group A and group B with 103 cases in each group.The patients in treatment group received 1g of TXA dissolved in 250 ml of normal saline by fast intravenous in-fusion before the end of the second knee operation,and patients in control group received an equal volume of normal saline at the same time.We compared data from two groups in terms of perioperative blood loss, blood transfusion and complication.Group t test was used to compare the data.Results There were no sig-nificant differences in intraoperative blood loss and transfusion (P >0.05).The amount of postoperative blood transfusion of both groups were (117.48±214.40)mL and (357.38±325.08)mL,which was signifi-cantly different (P <0.05).Total perioperative blood loss in both groups were(1 628.10±570.32)mL and (2 120.11±529.20)mL,which was also significantly different (P <0.05).The cases of subcutaneous ec-chymosis in both groups were 41 (39.81%)and 76 (73.79%)(χ2 =22.87,P <0.001).There was not sta-tistically significant difference in the coagulation indicators between preoperative and postoperative.No deep venous thrombosis was observed through Doppler ultrasound examination after 6 days and 1 mouth. Conclusion The intravenous infusion of tranexamic acid intraoperatively in primary bilateral TKA patients could significantly reduce the amount of perioperative blood loss and blood transfusion,hence the risk of blood transfusion and transfusion cost.The incidence of ecchymosis and the area of ecchymosis can be cut down signifi-cantly,which is good to patients′recovery from the operation and decrease the risk of DVT and PE.