作　　者： (周忠锋）; (冯虎）; (王云清）; (闫长明）; (李高玉）; (刘刚）;

机构地区： 徐州医科大学研究生学院,江苏徐州221004

出　　处： 《徐州医科大学学报》 2017年第8期505-509,共5页

摘　　要： 目的探讨氨甲环酸（tranexamic acid，TXA）序贯抗凝血药物在初次单侧全髋关节置换术（total hip arthroplasty，THA）围手术期的有效性及安全性。方法回顾性分析64例初次全髋关节置换患者临床资料，分为2组：静脉联合局部使用TXA组（实验组，34例）和未使用TXA组（对照组，30例）。实验组15mg／kg的TXA静脉滴注于全髋关节置换术切皮前10min完毕，缝合切口后经引流管推注1gTXA溶入20ml生理盐水，保留2h；对照组不使用TXA。2组患者术后抗凝方案：抗凝血药物低分子肝素（low molecular weight heparin, LMWH）手术结束6h后引流量少于30mE／h时首次进行，如大于30ml／h，最迟不超过12h使用，以后每隔24h使用。比较2组患者围手术期总失血量（显性失血量、隐性失血量）、输血率、下肢深静脉血栓（deep venous thrombosis，DVT）及肺栓塞（pulmonaryembolism，PE）发生率等指标评价方法的安全有效性。结果实验组的围手术期总失血量、隐性失血量、输血率均明显少于对照组（P〈0．05）；2组患者在置换后静脉血栓发生率差异无显著性意义（P〉0．05）。结论初次全髋关节置换术围手术期静脉联合局部应用TXA，序贯使用抗凝血药物，能降低患者置换后总失血量及输血率，促进患者早期恢复，并且没有增加下肢深静脉血栓形成的风险，是安全有效的。 Objective To investigate the efficacy and safety of sequential therapy of tranexamic acid （TXA） and anticoagulants for patients who initially underwent total hip arthroplasty （THA）. Methods Sixty -four patients initially undergoing total hip arthroplasty were randomly divided into two groups ： a test group （ n = 34） and a control group （ n = 30）. The test group was intravenously injected with 15 mg/kg TXA 10 rain （ivgtt） before replacement and infused with 1 g TXA in 20 ml normal saline after incision suturing and kept for 2 h. The control group was not treated with TXA. Fur- thermore, all patients first received low molecular weight heparin （LMWH） 6 h after surgery if the drainage volume was less than 30 ml/h or at least 12 h after surgery if the drainage volume was over 30 ml/h. LMWH was then used every 24 h. The two groups were compared for the total volumes of blood loss （dominant and hidden blood loss） in the periopera- five period, blood transfusion rate, and the incidence of deep vein thrombosis and pulmonary embolism. Results The test group showed remarkable decreases in the total volumes of perioperative blood loss, the bidden blood loss and the blood transfusion rate compared with the control group （ P 〈 0.05 ）. No significant difference was found in the incidence of vein thrombosis between the two groups （ P 〉 0.05 ）. Conclusions The intravenous and local administration of TXA and sequential use of anticoagulants is a safe and effective approach for patients initially undergoing total hip arthroplasty, which can reduce the total volume of perioperative blood loss and blood transfusion rate, without any impact on the inci- dence of deep vein thrombosis.

关 键 词： 氨甲环酸 抗凝 关节成形术 置换 髋关节