CAJ | 학술논문

背景：氨甲环酸在减少人工关节置换后出血方面的应用越来越多，但其使用方法及剂量仍存在争议，是近几年研究的热点。目的：观察静脉滴注联合局部应用氨甲环酸对减少初次全髋关节置换后隐性失血的有效性和安全性。方法：将65例初次全髋关节置换患者随机分为试验组与对照组。试验组患者于置换术中使用0.5 g氨甲环酸静脉滴注，缝合后经引流管推注0.5 g氨甲环酸，保留6 h；对照组给予生理盐水静脉滴注，缝合后经引流管推注50 mL生理盐水，保留6 h。对比两组患者的术中出血量、置换后显性失血及隐性失血量、疼痛评分、输血率、深静脉血栓形成情况及住院日。结果与结论：试验组置换后血红蛋白及红细胞压积均高于对照组(P <0.05)，置换后显性失血及隐性失血量均低于对照组(P <0.05)，输血率、住院日均少于对照组(P <0.05)；而两组术中出血量、疼痛评分、深静脉血栓形成发生率差异无显著性意义(P >0.05)。提示全髋关节置换过程中静脉滴注联合经引流管内注射氨甲环酸能降低患者置换后显性、隐性失血量及输血率，并且没有增加下肢深静脉血栓形成的风险。
배경：안갑배산재감소인공관절치환후출혈방면적응용월래월다，단기사용방법급제량잉존재쟁의，시근궤년연구적열점。목적：관찰정맥적주연합국부응용안갑배산대감소초차전관관절치환후은성실혈적유효성화안전성。방법：장65례초차전관관절치환환자수궤분위시험조여대조조。시험조환자우치환술중사용0.5 g안갑배산정맥적주，봉합후경인류관추주0.5 g안갑배산，보류6 h；대조조급여생리염수정맥적주，봉합후경인류관추주50 mL생리염수，보류6 h。대비량조환자적술중출혈량、치환후현성실혈급은성실혈량、동통평분、수혈솔、심정맥혈전형성정황급주원일。결과여결론：시험조치환후혈홍단백급홍세포압적균고우대조조(P <0.05)，치환후현성실혈급은성실혈량균저우대조조(P <0.05)，수혈솔、주원일균소우대조조(P <0.05)；이량조술중출혈량、동통평분、심정맥혈전형성발생솔차이무현저성의의(P >0.05)。제시전관관절치환과정중정맥적주연합경인류관내주사안갑배산능강저환자치환후현성、은성실혈량급수혈솔，병차몰유증가하지심정맥혈전형성적풍험。
BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE: To investigate the efficacy and safety of intravenous drip combined with intra-articular injection of tranexamic acid on postoperative hidden blood loss in patients who received primary total hip arthroplasty. METHODS:Clinical data of 65 patients undergoing primary total hip arthroplasty were randomized to the test group and the control group. The patients in the test group received 0.5 g tranexamic acid through intravenous drip when the surgery starts and 0.5 g tranexamic acid inside hip joint through a drainage tube after capsule closure, and retaining for 6 hours. The patients in the control group intravenously received the same volume of physiological saline, and 50 mL physiological saline through a drainage tube after suture, and retaining for 6 hours. We compared with intraoperative blood loss, postoperative dominant blood loss and hidden blood loss, pain score, blood transfusion rate, deep vein thrombosis and day of hospitalization in both groups. RESULTS AND CONCLUSION:Hemoglobin and hematocrit were higher in the test group than in the control group after replacement (P < 0.05). The volumes of dominant blood loss and hidden blood loss were lower in the test group than in the control group after replacement (P < 0.05). Blood transfusion rate and day of hospitalization were less in the test group than in the control group (P < 0.05). No significant difference in intraoperative blood loss, pain score and incidence of deep vein thrombosis was detectable between the two groups (P > 0.05). These results indicate that the intravenous drip combined intra-articular injection of tranexamic acid in patients receiving total hip arthroplasty could reduce the amounts of postoperative dominant and hidden blood loss and blood transfusion rate, and did not increase the incidence of deep vein thrombosis.