CAJ | 학술논문

目的：观察静脉联合局部应用氨甲环酸对单侧全膝关节置换术术中、术后出血量、输血量、血红蛋白值及凝血功能的影响并对其安全性加以评估。方法：将86例初次行单侧全膝关节置换术的患者随机分为治疗组和对照组，每组43例。治疗组在假体安装完成缝合开始时，给1 g氨甲环酸配入100 mL生理盐水静脉滴注；膝关节假体安装完缝合关节囊后，再给1 g氨甲环酸稀释于50 mL生理盐水注入关节腔内；术后3h再次静脉滴入1g氨甲环酸。对照组给予等量生理盐水静脉滴注。比较两组术中出血量、术后可见失血量、输血量、输血人数及术后血红蛋白值、术后纤维蛋白原、凝血酶原时间等检测结果；术后观察患者是否出现下肢深静脉栓塞的临床症状，术后1周行常规下肢深静脉多普勒超声检查。结果：两组术中失血量比较，差异无统计学意义（P >0.05），但术后失血量、输血量、输血人数比较，治疗组均明显低于对照组（P <0.05）；术后血红蛋白值比较，治疗组明显高于对照组（P <0.05）；两组术前和术后3h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间比较，差异无统计学意义（P >0.05）；术后1周下肢深静脉血栓形成率比较，差异无统计学意义（P >0.05）。结论：局部及联合静脉应用氨甲环酸在全膝关节置换术中及术后，能明显降低患者的术后失血量及输血量等，具有良好的止血效果且不增加静脉血栓形成的风险。
목적：관찰정맥연합국부응용안갑배산대단측전슬관절치환술술중、술후출혈량、수혈량、혈홍단백치급응혈공능적영향병대기안전성가이평고。방법：장86례초차행단측전슬관절치환술적환자수궤분위치료조화대조조，매조43례。치료조재가체안장완성봉합개시시，급1 g안갑배산배입100 mL생리염수정맥적주；슬관절가체안장완봉합관절낭후，재급1 g안갑배산희석우50 mL생리염수주입관절강내；술후3h재차정맥적입1g안갑배산。대조조급여등량생리염수정맥적주。비교량조술중출혈량、술후가견실혈량、수혈량、수혈인수급술후혈홍단백치、술후섬유단백원、응혈매원시간등검측결과；술후관찰환자시부출현하지심정맥전새적림상증상，술후1주행상규하지심정맥다보륵초성검사。결과：량조술중실혈량비교，차이무통계학의의（P >0.05），단술후실혈량、수혈량、수혈인수비교，치료조균명현저우대조조（P <0.05）；술후혈홍단백치비교，치료조명현고우대조조（P <0.05）；량조술전화술후3h섬유단백원、응혈매원시간화활화부분응혈활매시간비교，차이무통계학의의（P >0.05）；술후1주하지심정맥혈전형성솔비교，차이무통계학의의（P >0.05）。결론：국부급연합정맥응용안갑배산재전슬관절치환술중급술후，능명현강저환자적술후실혈량급수혈량등，구유량호적지혈효과차불증가정맥혈전형성적풍험。
[ABSTRACT]Objective:To explore the effect of intravenous and topical application of tranexamic acid on amount of bleeding and blood transfusion,content of hemoglobin and blood coagulation in the perioperative period of unilateral total knee replacement and its safety evaluation.Methods:86 patients who would undergo unilateral total knee replacement were randomly divided into a treatment group and a control group,43 cases in each.Patients of the treatment group were given intravenous drip of tranexamic acid(1 g) and physiological saline(100 mL) while stitching after prosthesis installation and given tranexamic acid(1 g) and physiological saline(50 mL) into the joint cavity after suturing the joint capsule.After 3 hours of replacement,they were again given intravenous infusion of 1 g tranexamic acid.Patients in the control group were given the same amount of normal saline.Compared intraoperative blood loss,postoperative blood loss,blood transfusion,blood donors,postoperative hemoglobin,postoperative ifbrinogen and prothrombin time of the two groups.Postoperative observation of patients was made for the possibility of deep venous embolism in lower limb.One week after operation,Doppler ultrasound for the deep vein was made.Results:The difference of blood loss between the two groups was not statistically significant (P >0.05),but the postoperative bloodloss,blood transfusion and blood donors of the treatment group were signiifcantly less than of the control group (P <0.05).The postoperative hemoglobin value of the treatment group was signiifcantly higher than that of the control group(P <0.05).The differences of fibrinogen,prothrombin time and activation time of partial thromboplastin between the two groups were not statistically signiifcant (P >0.05).The difference of deep vein thrombosis formation rate in lower extremity between the two groups was not statistically signiifcant (P >0.05) after one week of operation.Conclusion:Intravenous and topical application of tranexamic acid in total knee arthroplasty can signiifcantly decreased postoperative bleeding and blood transfusion,has a good hemostatic effect and does not increase the risk of venous thrombosis.