中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2015年
8期
808-812
,共5页
谢锦伟%岳辰%裴福兴%康鹏德
謝錦偉%嶽辰%裴福興%康鵬德
사금위%악신%배복흥%강붕덕
氨甲环酸%关节炎,类风湿%关节成形术,置换,髋%失血,手术
氨甲環痠%關節炎,類風濕%關節成形術,置換,髖%失血,手術
안갑배산%관절염,류풍습%관절성형술,치환,관%실혈,수술
Tranexamic acid%Arthritis,rheumatoid%Arthroplasty,replacement,hip%Blood loss,surgical
目的:探索氨甲环酸对类风湿关节炎患者全髋关节置换围手术期失血的影响。方法回顾性分析2012年6月至2014年6月行初次全髋关节置换术患者资料,仅纳入因类风湿关节炎(Steinbrocker 3、4级)行初次单侧全髋关节置换术患者数据,最终纳入197例。其中68例术前20 min静脉滴注氨甲环酸15 mg/kg(单次给药组),74例术前20 min静脉滴注氨甲环酸15 mg/kg+术后3 h再次静脉滴注氨甲环酸10 mg/kg(重复给药组),55例未使用氨甲环酸(对照组)。单次给药组女52例、男16例,平均年龄58岁;重复给药组女54例、男20例,平均年龄59岁;对照组女40例、男15例,平均年龄55岁。比较三组患者总失血量、输血率、深静脉血栓及肺栓塞发生率、术后引流量、术后血红蛋白下降值及并发症情况。结果单次给药组、重复给药组和对照组围手术期总失血量分别为(816.80±245.09)ml、(975.15±216.33)ml和(1295.68±263.85)ml,术后引流量为(221.60±70.05)ml、(337.20±113.10)ml和(479.74±120.66)ml,输血率为5.41%、10.29%和25.45%,术后血红蛋白降低值为(2.71±0.74)g/dl、(3.18±0.62)g/dl和(3.83±0.70)g/dl;各指标给药组均较对照组低,重复给药组较单次给药组围手术期总失血量、输血率、术后引流量更低。术后三组患者均未发生深静脉血栓及肺栓塞;单次给药组8例、重复给药组6例、对照组8例出现切口并发症,发生率分别为11.8%(8/68)、8.1%(6/74)、14.5%(8/55),三者比较差异无统计学意义(χ2=1.355,P=0.508)。结论静脉使用氨甲环酸可有效降低类风湿关节炎患者全髋关节置换围手术期总失血量与输血率,且不增加血栓事件的风险,相对于术前单次使用氨甲环酸,更推荐术前及术后3h重复给药。
目的:探索氨甲環痠對類風濕關節炎患者全髖關節置換圍手術期失血的影響。方法迴顧性分析2012年6月至2014年6月行初次全髖關節置換術患者資料,僅納入因類風濕關節炎(Steinbrocker 3、4級)行初次單側全髖關節置換術患者數據,最終納入197例。其中68例術前20 min靜脈滴註氨甲環痠15 mg/kg(單次給藥組),74例術前20 min靜脈滴註氨甲環痠15 mg/kg+術後3 h再次靜脈滴註氨甲環痠10 mg/kg(重複給藥組),55例未使用氨甲環痠(對照組)。單次給藥組女52例、男16例,平均年齡58歲;重複給藥組女54例、男20例,平均年齡59歲;對照組女40例、男15例,平均年齡55歲。比較三組患者總失血量、輸血率、深靜脈血栓及肺栓塞髮生率、術後引流量、術後血紅蛋白下降值及併髮癥情況。結果單次給藥組、重複給藥組和對照組圍手術期總失血量分彆為(816.80±245.09)ml、(975.15±216.33)ml和(1295.68±263.85)ml,術後引流量為(221.60±70.05)ml、(337.20±113.10)ml和(479.74±120.66)ml,輸血率為5.41%、10.29%和25.45%,術後血紅蛋白降低值為(2.71±0.74)g/dl、(3.18±0.62)g/dl和(3.83±0.70)g/dl;各指標給藥組均較對照組低,重複給藥組較單次給藥組圍手術期總失血量、輸血率、術後引流量更低。術後三組患者均未髮生深靜脈血栓及肺栓塞;單次給藥組8例、重複給藥組6例、對照組8例齣現切口併髮癥,髮生率分彆為11.8%(8/68)、8.1%(6/74)、14.5%(8/55),三者比較差異無統計學意義(χ2=1.355,P=0.508)。結論靜脈使用氨甲環痠可有效降低類風濕關節炎患者全髖關節置換圍手術期總失血量與輸血率,且不增加血栓事件的風險,相對于術前單次使用氨甲環痠,更推薦術前及術後3h重複給藥。
목적:탐색안갑배산대류풍습관절염환자전관관절치환위수술기실혈적영향。방법회고성분석2012년6월지2014년6월행초차전관관절치환술환자자료,부납입인류풍습관절염(Steinbrocker 3、4급)행초차단측전관관절치환술환자수거,최종납입197례。기중68례술전20 min정맥적주안갑배산15 mg/kg(단차급약조),74례술전20 min정맥적주안갑배산15 mg/kg+술후3 h재차정맥적주안갑배산10 mg/kg(중복급약조),55례미사용안갑배산(대조조)。단차급약조녀52례、남16례,평균년령58세;중복급약조녀54례、남20례,평균년령59세;대조조녀40례、남15례,평균년령55세。비교삼조환자총실혈량、수혈솔、심정맥혈전급폐전새발생솔、술후인류량、술후혈홍단백하강치급병발증정황。결과단차급약조、중복급약조화대조조위수술기총실혈량분별위(816.80±245.09)ml、(975.15±216.33)ml화(1295.68±263.85)ml,술후인류량위(221.60±70.05)ml、(337.20±113.10)ml화(479.74±120.66)ml,수혈솔위5.41%、10.29%화25.45%,술후혈홍단백강저치위(2.71±0.74)g/dl、(3.18±0.62)g/dl화(3.83±0.70)g/dl;각지표급약조균교대조조저,중복급약조교단차급약조위수술기총실혈량、수혈솔、술후인류량경저。술후삼조환자균미발생심정맥혈전급폐전새;단차급약조8례、중복급약조6례、대조조8례출현절구병발증,발생솔분별위11.8%(8/68)、8.1%(6/74)、14.5%(8/55),삼자비교차이무통계학의의(χ2=1.355,P=0.508)。결론정맥사용안갑배산가유효강저류풍습관절염환자전관관절치환위수술기총실혈량여수혈솔,차불증가혈전사건적풍험,상대우술전단차사용안갑배산,경추천술전급술후3h중복급약。
Objective To investigate the efficacy and safety of tranexamic acid on bleeding in rheumatoid arthritis (RA) patients undergoing total hip arthroplasty (THA). Methods A retrospective study was performed in 197 RA patients (Steinbrock?er III-IV) following primary unilateral THA from June 2012 to June 2014. The patients were divided to three groups based on the regimen of tranexamic acid:68 patients received a single intravenous dosage of 15 mg/kg tranexamic acid 20 min prior to opera?tion (single dose group);74 patients received an intravenous dosage of 15 mg/kg preoperatively and a second dosage of 10 mg/kg 3 hours postoperatively (repeated dose group);the other 55 patients didn't receive tranexamic acid (control group). The primary out?comes were total blood loss, transfusion rate, the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). The sec?ondary outcomes were postoperative drainage, hemoglobin (Hb) drop on third day postoperatively and other wound related compli?cations. Results There was less total blood loss (816.80 ± 245.09 ml vs 975.15 ± 216.33 ml vs 1 295.68 ± 263.85 ml), drainage (221.60 ± 70.05 ml vs 337.20 ± 113.10 ml vs 479.74 ± 120.66 ml), transfusion requirement (5.41%vs 10.29%vs 25.45%) and Hb drop (2.71±0.74 g/dl vs 3.18±0.62 g/dl vs 3.83±0.70 g/dl) in experimental group when compared with control group. And the effect was better in repeated dose group, with less total blood loss (816.80 ± 245.09 ml), less transfusion requirement (5.41%) and less postoperative drainage (221.60±70.05 ml). No episode of DVT or PE occurred in either group. There were 8 wound complications in single dose group, 6 in repeated group, and 8 in control group, and there were no statistically difference. Conclusion Intrave?nous administration of tranexamic acid was effective and safe on decreasing blood loss and transfusion requirement in RA patients following THA. Compared with a single dosage of tranexamic acid preoperatively, a second dosage of tranexamic acid 3 hours post?operatively was recommended.