CAJ | 학술논문

目的：探讨全膝关节置换（ TKA）术中使用氨甲环酸（ TXA）的有效性和安全性。方法2010年3月至2013年3月，对88例（88膝）行初次TKA术的退变性骨关节炎患者进行前瞻性、随机化研究。患者随机分为使用TXA （ TXA组）和使用安慰剂（对照组）两组。 TXA组，在松止血带前15 min静脉给予15 mg／kg剂量的TXA；对照组给予等量的生理盐水。共11例失访（ TXA组，5例；对照组，6例），剩下77例（ TXA组，39例；对照组38例）患者纳入最终分析，对其术中失血量、术后24 h引流量、总引流量、隐性失血量、总失血量、输血量、和术后第3天血红蛋白，术后24 h D－二聚体，下肢瘀斑发生率、深静脉血栓（ DVT）发生率进行评估。结果两组患者术前一般资料如年龄（ t＝0.390， P＞0.05）、性别比（χ2＝0.127， P＞0.05）、合并疾病（χ2＝0.142， P＞0.05）等差异均无统计学意义，具有可比性。 TXA组术后24 h引流量（t ＝6.512， P＜0.01）、总引流量（t ＝4.913， P ＜0.01）、隐性失血量（t＝5.980， P＜0.01）、总失血量（t＝5.808， P＜0.01）、24 h D－二聚体值（t＝18.401， P＜0.01）均明显低于对照组；TXA组术后第3天血红蛋白量明显高于对照组（ t＝4.815， P＜0.01）；TXA组和对照组分别有3例（共1200 ml）和4例（共1400 ml）患者接受异体输血（ P＞0.05）。 TXA组和对照组下肢远端深静脉血栓均为3例（P＞0.05）。 TXA组下肢瘀斑发生率明显低于对照组（2.6％vs.18.4％，P＜0.05）。结论静脉使用TXA，能够安全有效的减少TKA围手术期失血量，不增加深静脉血栓的风险。
목적：탐토전슬관절치환（ TKA）술중사용안갑배산（ TXA）적유효성화안전성。방법2010년3월지2013년3월，대88례（88슬）행초차TKA술적퇴변성골관절염환자진행전첨성、수궤화연구。환자수궤분위사용TXA （ TXA조）화사용안위제（대조조）량조。 TXA조，재송지혈대전15 min정맥급여15 mg／kg제량적TXA；대조조급여등량적생리염수。공11례실방（ TXA조，5례；대조조，6례），잉하77례（ TXA조，39례；대조조38례）환자납입최종분석，대기술중실혈량、술후24 h인류량、총인류량、은성실혈량、총실혈량、수혈량、화술후제3천혈홍단백，술후24 h D－이취체，하지어반발생솔、심정맥혈전（ DVT）발생솔진행평고。결과량조환자술전일반자료여년령（ t＝0.390， P＞0.05）、성별비（χ2＝0.127， P＞0.05）、합병질병（χ2＝0.142， P＞0.05）등차이균무통계학의의，구유가비성。 TXA조술후24 h인류량（t ＝6.512， P＜0.01）、총인류량（t ＝4.913， P ＜0.01）、은성실혈량（t＝5.980， P＜0.01）、총실혈량（t＝5.808， P＜0.01）、24 h D－이취체치（t＝18.401， P＜0.01）균명현저우대조조；TXA조술후제3천혈홍단백량명현고우대조조（ t＝4.815， P＜0.01）；TXA조화대조조분별유3례（공1200 ml）화4례（공1400 ml）환자접수이체수혈（ P＞0.05）。 TXA조화대조조하지원단심정맥혈전균위3례（P＞0.05）。 TXA조하지어반발생솔명현저우대조조（2.6％vs.18.4％，P＜0.05）。결론정맥사용TXA，능구안전유효적감소TKA위수술기실혈량，불증가심정맥혈전적풍험。
Objective To investigate the effectiveness and safety of intraoperative usage of tranexamic acid (TXA) in total knee arthroplasty (TKA).Methods Between March 2010 and March 2013, 88 patients (88 knees) undergoing primary TKA for the treatment of primary OA were enrolled in this study.All the patients were randomized into TXA group who received 15 mg/kg TXA at 15 min before loosening the tourniquet and the control group who received the same amount of saline solution .Eleven patients (five in the TXA group and six in the control group ) were lost of follow-up, and 77 patients (39 in the TXA group and 38 in the control group ) were available for analysis .The patients were assessed by the intraoperative blood loss , postoperative drainage at 24 h, total drainage volume , hidden blood loss , total blood loss, transfusion volumes, the number of transfusion, postoperative hemoglobin (Hgb) at 3 d, 24 h D-dimer, ecchymosis and deep vein thrombosis ( DVT) .Results The preoperative general information of the patients in both groups were not statistically significant , such as age ( t =0.390, P >0.05 ) , sex (χ2=0.127,P>0.05), and the comorbidities (χ2=0.142,P>0.05).The statistical differences were detected between the two groups in terms of the postoperative Hgb at 3 d ( t =4.815, P<0.01), the postoperative D-dimer at 24 h (t=18.401, P<0.01), the postoperative drainage at 24 h (t =6.512, P<0.01), the postoperative drainage amount (t=4.913, P<0.01), the hidden blood loss (t=5.980, P<0.01), the amount of blood loss (t=5.808, P<0.01) and the postoperative incidence of ecchymosis (2.6%vs.18.4%,P<0.05).No statistical difference was detected between the two groups in terms of transfusion (P>0.05), and the incidence of DVT (P>0.05).Conclusion The present study suggests that the use of TXA could significantly reduce blood loss and do not increase the risk of DVT after TKA .