中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2013年
1期
40-43
,共4页
关节成形术,置换,膝%氨甲环酸%手术期间%治疗结果
關節成形術,置換,膝%氨甲環痠%手術期間%治療結果
관절성형술,치환,슬%안갑배산%수술기간%치료결과
Arthroplasty,replacement,knee%Tranexamic acid%Intra operative period%Treatment outcome
目的 探讨局部应用氨甲环酸对单侧全膝关节置换术患者出血量的影响.方法 对2011年3月至2012年3月符合纳入标准的95例行初次单侧全膝关节置换术的患者资料进行了回顾性分析,其中男性23例,女性72例；年龄60～87岁,平均(71±4)岁.其中实验组53例患者局部应用氨甲环酸术中止血,未曾使用氨甲环酸的42例患者作为对照组,两组患者的年龄、身高、体重指数及疾病诊断等参数的差异均无统计学意义(P＞0.05).记录术中及术后失血量和输血量,观察患者是否出现下肢深静脉栓塞症状及下肢皮肤情况.术前和术后3h检查D-二聚体和相关凝血指标,术后连续复查血常规.两组间比较采用成组t检验.结果 实验组和对照组术中出血量比较差异无统计学意义(P＞0.05),术后可见失血量和隐性失血量两组差异均有统计学意义(t=17.51和64.18,P＜0.05).两组的输血量分别为(470±150) ml和(708±245) ml,术后血红蛋白浓度和红细胞压积对照组明显低于实验组(t=-18.88和-13.05,P＜0.05).患者术后经血管多普勒超声检查均未发现下肢深静脉血栓形成.术后3h实验组和对照组的D-二聚体为(0.91±0.44)和(1.21±0.65)mg/L,均明显高于术前的(0.36±0.11)和(0.37±0.14) mg/L,差异具有统计学意义(t=5.40和44.68,P＜0.05),且对照组高于实验组(t=1.99,P＜0.05).两组间凝血指标术后比较差异无统计学意义(P＞0.05).结论 全膝关节置换术中局部应用氨甲环酸能明显减少术后出血量,降低输血率,降低患者围手术期的贫血相关并发症的风险,且操作简单、安全、经济.
目的 探討跼部應用氨甲環痠對單側全膝關節置換術患者齣血量的影響.方法 對2011年3月至2012年3月符閤納入標準的95例行初次單側全膝關節置換術的患者資料進行瞭迴顧性分析,其中男性23例,女性72例；年齡60～87歲,平均(71±4)歲.其中實驗組53例患者跼部應用氨甲環痠術中止血,未曾使用氨甲環痠的42例患者作為對照組,兩組患者的年齡、身高、體重指數及疾病診斷等參數的差異均無統計學意義(P＞0.05).記錄術中及術後失血量和輸血量,觀察患者是否齣現下肢深靜脈栓塞癥狀及下肢皮膚情況.術前和術後3h檢查D-二聚體和相關凝血指標,術後連續複查血常規.兩組間比較採用成組t檢驗.結果 實驗組和對照組術中齣血量比較差異無統計學意義(P＞0.05),術後可見失血量和隱性失血量兩組差異均有統計學意義(t=17.51和64.18,P＜0.05).兩組的輸血量分彆為(470±150) ml和(708±245) ml,術後血紅蛋白濃度和紅細胞壓積對照組明顯低于實驗組(t=-18.88和-13.05,P＜0.05).患者術後經血管多普勒超聲檢查均未髮現下肢深靜脈血栓形成.術後3h實驗組和對照組的D-二聚體為(0.91±0.44)和(1.21±0.65)mg/L,均明顯高于術前的(0.36±0.11)和(0.37±0.14) mg/L,差異具有統計學意義(t=5.40和44.68,P＜0.05),且對照組高于實驗組(t=1.99,P＜0.05).兩組間凝血指標術後比較差異無統計學意義(P＞0.05).結論 全膝關節置換術中跼部應用氨甲環痠能明顯減少術後齣血量,降低輸血率,降低患者圍手術期的貧血相關併髮癥的風險,且操作簡單、安全、經濟.
목적 탐토국부응용안갑배산대단측전슬관절치환술환자출혈량적영향.방법 대2011년3월지2012년3월부합납입표준적95례행초차단측전슬관절치환술적환자자료진행료회고성분석,기중남성23례,녀성72례；년령60～87세,평균(71±4)세.기중실험조53례환자국부응용안갑배산술중지혈,미증사용안갑배산적42례환자작위대조조,량조환자적년령、신고、체중지수급질병진단등삼수적차이균무통계학의의(P＞0.05).기록술중급술후실혈량화수혈량,관찰환자시부출현하지심정맥전새증상급하지피부정황.술전화술후3h검사D-이취체화상관응혈지표,술후련속복사혈상규.량조간비교채용성조t검험.결과 실험조화대조조술중출혈량비교차이무통계학의의(P＞0.05),술후가견실혈량화은성실혈량량조차이균유통계학의의(t=17.51화64.18,P＜0.05).량조적수혈량분별위(470±150) ml화(708±245) ml,술후혈홍단백농도화홍세포압적대조조명현저우실험조(t=-18.88화-13.05,P＜0.05).환자술후경혈관다보륵초성검사균미발현하지심정맥혈전형성.술후3h실험조화대조조적D-이취체위(0.91±0.44)화(1.21±0.65)mg/L,균명현고우술전적(0.36±0.11)화(0.37±0.14) mg/L,차이구유통계학의의(t=5.40화44.68,P＜0.05),차대조조고우실험조(t=1.99,P＜0.05).량조간응혈지표술후비교차이무통계학의의(P＞0.05).결론 전슬관절치환술중국부응용안갑배산능명현감소술후출혈량,강저수혈솔,강저환자위수술기적빈혈상관병발증적풍험,차조작간단、안전、경제.
Objective To investigate the efficacy and safety of tranexamic acid in patients who receiving unilateral total knee arthroplasty (TKA).Methods From March 2011 to March 2012,clinical data of 95 patients who received primary unilateral TKA were analyzed retrospectively,including 23 male and 72 female patients,age from 60 to 87 years,mean (71 ±4) years.The patients in treatment group received 0.5 g of tranexamic acid inside knee joint after capsule closure,and patients in control group did not receive tranexamic acid.Two groups of patient's age,height,weight and disease diagnosis and other parameters of the differences were no statistical significance (P ＞ 0.05).The amounts of intraoperative blood loss,postoperative visible blood loss,the hidden blood loss,and blood transfusion,the number of patients needing blood transfusion,symptoms of deep venous thrombosis and lower extremity ecchymosis were observed.The values of preoperative and 3 hours of postoperative D-dimer and related coagulation markers were recorded.Group t test was used to compare between the two groups.Results There were no significant differences in intraoperative blood loss (P ＞ 0.05).The amounts of postoperative visible blood loss,the hidden blood loss was significant different (t =17.51 and 64.18,P ＜ 0.05).Transfusion of both groups were (470 ± 150)ml and (708 ± 245)ml.The value of postoperative hemoglobin and hematocrit was lower in control group as compared with those in treatment group (t =-18.88 and-13.05,P ＜ 0.05).No deep venous thrombosis was observed through Doppler ultrasound examination.Postoperative 3 hours D-dimer in the two groups for (0.91 ±0.44) and (1.21 ±0.65) mg/L,were significantly higher than that of preoperative (0.36 ±0.11) and (0.37 ±0.14)mg/L,with a statistically significant difference (t =5.40 and 44.68,P ＜ 0.05),and the control group was higher than treatment group (t =1.99,P ＜ 0.05).There was not statistically significant difference between the coagulation indicators of the two groups.Conclusions The local application of tranexamic acid intraoperatively in unilateral TKA patients could significantly reduce the amounts of postoperative blood loss and blood transfusion to avoid TKA patients' perioperative anemiarelated complications.It is also safe,ecnomic and easy to use during surgery.
