CAJ | 학술논문

目的探讨不同时间点静脉滴注氨甲环酸对同期双侧全膝关节置换术(TKA)围手术期出血及术后静脉血栓栓塞(VTE)的影响. 方法回顾性分析2012年2月至2014年2月期间初次行双侧TKA的52例膝关节骨性关节炎患者(男25例,女27例;年龄为50 ～ 75岁),按用药方案不同分为4组(n=13):A组在术前30 min及关闭切口前30 min静脉滴注氨甲环酸,B组在术前30 min静脉滴注氨甲环酸,C组在关闭切口前30 min静脉滴注氨甲环酸,D组不使用氨甲环酸.记录并比较各组患者术后引流量、输血率、血红蛋白(Hb)值、术后24 h凝血指标、疼痛视觉模拟评分(VAS)、术后3d患膝被动屈伸活动度及VTE发生率等.结果 A、B、C组患者术后24 h引流量及总引流量显著少于D组患者,而A组患者又显著少于B、C组患者;A组患者术后24、72 h的Hb值显著高于B、C、D组患者,B、C组患者又显著高于D组患者;A、B、C组患者的输血率(15％、23％、30％)显著低于D组患者(53％);A组患者术后24、36 h疼痛VAS评分显著低于B、C、D组患者,以上项目比较差异均有统计学意义(P＜0.05).4组患者术后24 h凝血指标、术后3d患膝被动屈伸活动度比较差异均无统计学意义(P＞0.05).4组患者均未出现VTE临床症状. 结论氨甲环酸在减少同期双侧TKA患者术后出血和输血率的同时,并不会增加VTE的发生,不影响膝关节术后早期被动功能锻炼.术前30 min及关闭切口前30 min静脉滴注氨甲环酸效果最佳.
목적 탐토불동시간점정맥적주안갑배산대동기쌍측전슬관절치환술(TKA)위수술기출혈급술후정맥혈전전새(VTE)적영향. 방법 회고성분석2012년2월지2014년2월기간초차행쌍측TKA적52례슬관절골성관절염환자(남25례,녀27례;년령위50 ～ 75세),안용약방안불동분위4조(n=13):A조재술전30 min급관폐절구전30 min정맥적주안갑배산,B조재술전30 min정맥적주안갑배산,C조재관폐절구전30 min정맥적주안갑배산,D조불사용안갑배산.기록병비교각조환자술후인류량、수혈솔、혈홍단백(Hb)치、술후24 h응혈지표、동통시각모의평분(VAS)、술후3d환슬피동굴신활동도급VTE발생솔등.결과 A、B、C조환자술후24 h인류량급총인류량현저소우D조환자,이A조환자우현저소우B、C조환자;A조환자술후24、72 h적Hb치현저고우B、C、D조환자,B、C조환자우현저고우D조환자;A、B、C조환자적수혈솔(15％、23％、30％)현저저우D조환자(53％);A조환자술후24、36 h동통VAS평분현저저우B、C、D조환자,이상항목비교차이균유통계학의의(P＜0.05).4조환자술후24 h응혈지표、술후3d환슬피동굴신활동도비교차이균무통계학의의(P＞0.05).4조환자균미출현VTE림상증상. 결론 안갑배산재감소동기쌍측TKA환자술후출혈화수혈솔적동시,병불회증가VTE적발생,불영향슬관절술후조기피동공능단련.술전30 min급관폐절구전30 min정맥적주안갑배산효과최가.
Objective To investigate the effects of intravenous tranexamic acid (TA) drips at different time points on perioperative hemorrhage and postoperative venous thromboembolism (VTE) following bilateral primary total knee arthroplasty (TKA).Methods We reviewed 52 patients who had undergone primary bilateral TKA from February 2012 to February 2014.They were 25 men and 27 women, 50 to 75 years of age.They were divided into 4 even groups (n =13) according to timing of medication.Group A received a dose of 15 mg/kg TA intravenously 30 minutes preoperation and 30 minutes before wound closure;group B received a dose of 15 mg/kg TA intravenously 15 minutes preoperation;group C received 15 mg/kg TA intravenously 30 minutes before wound closure;group D received an equal volume of normal saline before surgery.The following indexes were recorded: 24 h postoperative drainage volume;total drainage volume;blood transfusion rate;postoperative haemoglobin (Hb) levels at 24 h, 72 h and 7 d;postoperative prothrombin time (PT);activated partial thromboplastin time (APIT);fibrinogen (FIB);visual analogue scale (VAS) at 24 h & 36 h postoperation;level of bilateral knee passive movement 3 days after surgery and VTE incidence.Patients' lower limbs were examined with Doppler ultrasound 2 weeks postoperatively.Results The 24h postoperative drainage volume and total drainage volume in groups A, B & C were significantly lower than in group D with group A being significantly less than groups B & C (P ＜ 0.05).The postoperative Hb levels at 24 h and 72 h in group A were significantly higher than those in the other groups while those in groups B & C significantly higher than in group D (P ＜ 0.05).The blood transfusion rate in groups A, B & C (15％, 23％ and 30％) was significantly lower than that in group D (53%) (P ＜0.05).The VAS scores at 24 h & 36 h postoperation in group A were significantly lower than in the other groups (P ＜0.05).There were no statistically significant differences between the 4 groups in PT, APTT or FIB 24 h postoperation or in level of bilateral knee passive movement 3 days after surgery (P ＞ 0.05).No VTE occurred in any of the 4 groups.Conclusions In bilateral primary total knee arthroplasty, intravenous TA drips can reduce postoperative hemorrhage and blood transfusion rate but may not increase the risk of VTE or hinder passive movement rehabilitation of the knee early after the surgery.The intravenous infusion of 15 mg/kg of TA 30 minutes preoperation and 30 minutes before wound closure may lead to optimal efficacy.