CAJ | 학술논문

背景：双膝关节置换后出血量及输血需求较大，因此氨甲环酸等止血药物在全膝关节置换中的应用成为近来的研究热点，大量研究证明氨甲环酸能有效减少该类患者的失血量，但专门针对双侧全膝关节置换患者的研究较少。目的：观察氨甲环酸对双侧全膝关节置换患者围术期出血量、血红蛋白变化的影响，并探讨其安全性。方法：选取69例需进行双侧全膝关节置换的患者，随机分为两组，试验组给予氨甲环酸1 g溶于100 mL 5%葡萄糖溶液中静脉滴注，对照组给予5%葡萄糖溶液100 mL静脉滴注。比较两组患者的总失血量、术中失血量、隐性失血量、置换后引流量、输血率、血红蛋白、D-二聚体、凝血酶原时间和活化部分凝血酶时间等指标的动态变化情况，并对比两组患者血栓事件的发生率。结果与结论：试验组的失血量明显低于对照组(t=2.194-2.908，P <0.05)，输血率也明显低于对照组(χ2=5.219，P=0.022)。比较置换后第3天和第5天的血红蛋白量，试验组明显高于对照组(t=-3.481，2.319， P <0.05)。置换前、置换后两组患者的凝血酶原时间、活化部分凝血酶时间差异无显著性意义(P >0.05)。两组患者置换后均未出现血栓栓塞事件，置换后下肢静脉彩超检查未见深静脉血栓形成。上述结果提示氨甲环酸能显著减少双侧全膝关节置换患者的围术期失血量，降低对输血的需求，减少血红蛋白的动态变化，同时不增加血栓形成的风险。
배경：쌍슬관절치환후출혈량급수혈수구교대，인차안갑배산등지혈약물재전슬관절치환중적응용성위근래적연구열점，대량연구증명안갑배산능유효감소해류환자적실혈량，단전문침대쌍측전슬관절치환환자적연구교소。목적：관찰안갑배산대쌍측전슬관절치환환자위술기출혈량、혈홍단백변화적영향，병탐토기안전성。방법：선취69례수진행쌍측전슬관절치환적환자，수궤분위량조，시험조급여안갑배산1 g용우100 mL 5%포도당용액중정맥적주，대조조급여5%포도당용액100 mL정맥적주。비교량조환자적총실혈량、술중실혈량、은성실혈량、치환후인류량、수혈솔、혈홍단백、D-이취체、응혈매원시간화활화부분응혈매시간등지표적동태변화정황，병대비량조환자혈전사건적발생솔。결과여결론：시험조적실혈량명현저우대조조(t=2.194-2.908，P <0.05)，수혈솔야명현저우대조조(χ2=5.219，P=0.022)。비교치환후제3천화제5천적혈홍단백량，시험조명현고우대조조(t=-3.481，2.319， P <0.05)。치환전、치환후량조환자적응혈매원시간、활화부분응혈매시간차이무현저성의의(P >0.05)。량조환자치환후균미출현혈전전새사건，치환후하지정맥채초검사미견심정맥혈전형성。상술결과제시안갑배산능현저감소쌍측전슬관절치환환자적위술기실혈량，강저대수혈적수구，감소혈홍단백적동태변화，동시불증가혈전형성적풍험。
BACKGROUND:The blood loss and the need of blood transfusion after bilateral total knee arthroplasty are very high. Therefore, the use of medicine such as tranexamic acid in total knee arthroplasty is overheated in recent years. Tranexamic acid has been proved to be able to decrease the blood loss after total knee arthroplasty, while the study of its use in bilateral total knee arthroplasty is seldom. OBJECTIVE:To observe the effect and safety of tranexamic acid on perioperative blood loss and the change of hemoglobin in patients undergoing bilateral total knee arthroplasty. METHODS: We selected 69 patients who received bilateral total knee arthroplasty and divided them into two different groups randomly. The patients in the experimental group were given 1 g of tranexamie acid dissolved in 100 mL of 5% glucose solution through intravenous infusion. Those in control group were only given 5% glucose solution 100 mL. Total blood loss, intraoperative blood loss, the hidden blood loss, amount of postoperative drainage, the ratio of blood transfusion, hemoglobin, D-dimer, prothrombin time and activated partial thromboplastin time were studied and compared between the two groups. We also observed the incidence of thrombotic events between the two groups. RESULTS AND CONCLUSION:The blood loss of the experimental group was significantly lower compared to the control group (t=2.194-2.908,P < 0.05). The blood transfusion rate of experimental group was significantly lower compared to the control group (χ2=5.219,P=0.022). The hemoglobin of the experimental group was significantly higher than that of the control group at 3 and 5 days after replacement (t=-3.481, 2.319,P < 0.05). No significant difference in prothrombin time and activated partial thromboplastin time was detectable between the two groups before and after replacement (P > 0.05). Thrombotic events were not visible in both groups. Venous ultrasonography in the lower extremity did not reveal deep venous thrombosis. Above results suggest that tranexamic acid can significantly reduce intraoperative blood loss in patients undergoing bilateral total knee arthroplasty, decreases the requirement of blood transfusion and the dynamic change of hemoglobin, and does not increase the risk of thrombosis.