CAJ | 학술논문

背景：人工全膝关节置换过程中，止血带的使用、手术创伤等因素会导致纤溶系统的异常激活，是术后失血的主要原因。氨甲环酸是一类抗纤溶药物，在人工全膝关节置换中使用，可减少置换后显性失血、总失血量，并降低异体血输血率。然而，氨甲环酸对人工全膝关节置换后隐性失血的影响尚未明确。目的：观察静脉输注氨甲环酸对初次全膝关节置换后隐性失血的影响。方法：回顾性分析2013年6至12月北京大学第三医院行初次单侧全膝关节置换54例患者的临床资料，按照是否使用氨甲环酸分为两组。氨甲环酸组22例在术中经静脉给予总量2 g的氨甲环酸，对照组32例使用等量生理盐水。两组患者置换后均口服利伐沙班抗凝。记录患者置换前及置换后连续5 d的血红蛋白、血红细胞压积，采用Gross方程计算总失血量和隐性失血量，比较两组间失血量的差异性。置换后1周行下肢静脉超声检查，判断有无下肢深静脉血栓形成。结果与结论：两组患者一般资料、围术期情况等比较差异均无显著性意义(P >0.05)。氨甲环酸组患者置换后引流量、显性失血量、总失血量、自体血回输量、异体血输注量均明显少于对照组，差异有显著性意义(P <0.05)。根据Gross方程计算隐性失血量，氨甲环酸组为(302.9±189.9) mL，对照组为(596.8±271.4) mL，差异有显著性意义(P <0.05)。置换后两组各发生1例下肢肌间静脉血栓。提示静脉输注氨甲环酸能显著减少单侧全膝关节置换后隐性失血量，降低异体血输血量，同时不增加下肢静脉血栓的发生率。
배경：인공전슬관절치환과정중，지혈대적사용、수술창상등인소회도치섬용계통적이상격활，시술후실혈적주요원인。안갑배산시일류항섬용약물，재인공전슬관절치환중사용，가감소치환후현성실혈、총실혈량，병강저이체혈수혈솔。연이，안갑배산대인공전슬관절치환후은성실혈적영향상미명학。목적：관찰정맥수주안갑배산대초차전슬관절치환후은성실혈적영향。방법：회고성분석2013년6지12월북경대학제삼의원행초차단측전슬관절치환54례환자적림상자료，안조시부사용안갑배산분위량조。안갑배산조22례재술중경정맥급여총량2 g적안갑배산，대조조32례사용등량생리염수。량조환자치환후균구복리벌사반항응。기록환자치환전급치환후련속5 d적혈홍단백、혈홍세포압적，채용Gross방정계산총실혈량화은성실혈량，비교량조간실혈량적차이성。치환후1주행하지정맥초성검사，판단유무하지심정맥혈전형성。결과여결론：량조환자일반자료、위술기정황등비교차이균무현저성의의(P >0.05)。안갑배산조환자치환후인류량、현성실혈량、총실혈량、자체혈회수량、이체혈수주량균명현소우대조조，차이유현저성의의(P <0.05)。근거Gross방정계산은성실혈량，안갑배산조위(302.9±189.9) mL，대조조위(596.8±271.4) mL，차이유현저성의의(P <0.05)。치환후량조각발생1례하지기간정맥혈전。제시정맥수주안갑배산능현저감소단측전슬관절치환후은성실혈량，강저이체혈수혈량，동시불증가하지정맥혈전적발생솔。
BACKGROUND:Massive blood loss was caused by an over-reactive fibrinolytic system, as a sequence of tourniquet usage and surgery trauma in total knee arthroplasty. As an antifibrinolytic drug, tranexamic acid has been proven to decrease not only the obvious and total blood loss, but also the ratio of alograft blood transfusion in total knee arthroplasty. Nevertheless, the effect of tranexamic acid on hidden blood loss in total knee arthroplasty had not been clarified yet. OBJECTIVE: To observe the effect of intravenous infusion of tranexamic acid on hidden blood loss in primary total knee arthroplasty. METHODS:Clinical data of 54 patients who received primary unilateral total knee arthroplasty in the Third Hospital, Peking University from June to December 2013 were retrospectively analyzed. They were divided into two groups according to the use of tranexamic acid. 22 patients in the tranexamic acid group were given 2 g tranexamic acid by intravenous infusion during surgery. 32 patients in the control group were given an equal volume of physiological saline. Patients in both groups were oraly given anticoagulant rivaroxaban after replacement. Hemoglobin level and blood hematocrit were recorded before and after surgery for 5 consecutive days. The total amount of blood loss and hidden blood loss were calculated by using Cross equation. The difference in the amount of blood loss was compared between the two groups. Lower extremity venous ultrasound examination was conducted at 1 week after replacement to determine deep venous thrombosis in the lower limb. RESULTS AND CONCLUSION:No significant difference in general data and perioperative conditions was detected between the two groups (P > 0.05). Postoperative drainage, dominant blood loss, total blood volume, the amount of autologous blood transfusion and the amount of alogeneic blood transfusion were significantly less in the tranexamic acid group than in the control group (P < 0.05). According to Gross formula, the difference of hidden blood loss was statisticaly significant between the tranexamic acid group (302.9±189.9) mL and the control group (596.8±271.4) mL (P < 0.05). Deep vein thrombosis appeared in one case between the two groups after replacement. Results indicate that intravenous infusion of tranexamic acid dramaticaly decreased the hidden blood loss in unilateral total knee arthroplasty, reduced alogeneic blood transfusion, and simultaneously did not increase the incidence of deep vein thrombosis in the lower limb.