氨甲环酸减少膝关节周围骨折围手术期失血的临床研究
|
摘要
[目的]探讨氨甲环酸减少膝关节周围骨折围术期失血的有效性及安全性。[方法]选取徐州市中心医院2015年1月～2018年4月收治的膝关节周围骨折患者108例为研究对象。采用随机数字表法将108例患者分为A、B、C和D组,每组27例。A组为对照组,应用生理盐水。B组、C组和D组分别静脉应用、局部应用和联合应用氨甲环酸。记录各组止血带使用时间、术中失血量、总失血量、隐性失血量和术后24 h引流量;术后3 d血红蛋白减少量、平均红细胞比容下降最大值和术后24 h D-二聚体;并发症发生情况以及输血率。[结果] 4组手术均在3h内完成。4组术中止血带使用时间及术中失血量比较,差异无统计学意义(P>0.05)。B、C、D组总失血量和隐性失血量组间均显著低于A组(P<0.05),D组总失血量和隐性失血量显著低于B组和C组(P<0.05)。A～D组血红蛋白减少量和平均红细胞比容下降最大值呈逐渐降低趋势,血红蛋白减少量各组间比较差异均无统计学意义(P>0.05),平均红细胞比容下降最大值各组间比较差异具有统计学意义(P<0.05)。C组和D组术后24 h D-二聚体水平显著低于A组和B组,且C组和D组比较差异有统计学意义(P<0.05)。所有患者术后均无下肢深静脉血栓形成及肺栓塞发生。D组1例患者术后第3 d白蛋白为28 g/L,静脉输入人血白蛋白20 g;其余患者均未输血。[结论]静脉和局部应用氨甲环酸均可明显减少膝关节周围骨折患者围术期失血量,且不增加深静脉血栓的发生率,联合应用效果更佳。
[Objective] To investigate the efficacy and safety of tranexamic acid reducing perioperative blood loss in fractures around the knee. [Methods] A total of 108 patients who were surgically treated for fractures around the knee from January2015 to April 2018 in our hospital were included into this study. The 108 patients were equally divided into Groups A, B, C, and D by random number table, with 27 patients in each group. Normal saline was given in the Group A as blank control, while tranexamic acid was applied intravenously, topically and jointly in the Group B, C and D respectively. The tourniquet time, intraoperative blood loss, total blood loss, hidden blood loss and drainage volume at 24 hours after operation were recorded. In addition, laboratory tests, such as hemoglobin, hematocrit, and D-dimer, as well as complications and blood transfusion rates were compared among the 4 groups. [Results] All patients in the 4 group had surgical operations finished within 3 hours. There was no significant difference in tourniquet time and intraoperative blood loss among the 4 groups(P>0.05). The total blood loss and hidden blood loss in the Group B, C and D were significantly lower than the Group A(P<0.05), while those in the Group D significantly lower than the Group B and C(P<0.05). There was no significant difference between groups in hemoglobin reduction and mean erythrocyte specific volume(P>0.05). There was significant difference between groups in mean erythrocyte specific volume and hemoglobin reduction(P<0.05). The D-dimer levels in group C and group D were significantly lower than those in group A and B at 24 hours after operation, and the differences between group C and group D were statistically significant(P<0.05). No deep venous thrombosis and pulmonary embolism occurred in any patients of the 4 groups. Except 1 patient who received 20 g of human albumin intravenously due to albumin of 28 g/L at 3 days postoperatively in the Group D, none patients had blood transfusion. [Conclusion] Both intravenous and topical application of tranexamic acid do significantly reduce the perioperative blood loss in fractures around the knee without increasing risk of deep vein thrombosis, and the combined intravenous and topical application get better results.
[Objective] To investigate the efficacy and safety of tranexamic acid reducing perioperative blood loss in fractures around the knee. [Methods] A total of 108 patients who were surgically treated for fractures around the knee from January2015 to April 2018 in our hospital were included into this study. The 108 patients were equally divided into Groups A, B, C, and D by random number table, with 27 patients in each group. Normal saline was given in the Group A as blank control, while tranexamic acid was applied intravenously, topically and jointly in the Group B, C and D respectively. The tourniquet time, intraoperative blood loss, total blood loss, hidden blood loss and drainage volume at 24 hours after operation were recorded. In addition, laboratory tests, such as hemoglobin, hematocrit, and D-dimer, as well as complications and blood transfusion rates were compared among the 4 groups. [Results] All patients in the 4 group had surgical operations finished within 3 hours. There was no significant difference in tourniquet time and intraoperative blood loss among the 4 groups(P>0.05). The total blood loss and hidden blood loss in the Group B, C and D were significantly lower than the Group A(P<0.05), while those in the Group D significantly lower than the Group B and C(P<0.05). There was no significant difference between groups in hemoglobin reduction and mean erythrocyte specific volume(P>0.05). There was significant difference between groups in mean erythrocyte specific volume and hemoglobin reduction(P<0.05). The D-dimer levels in group C and group D were significantly lower than those in group A and B at 24 hours after operation, and the differences between group C and group D were statistically significant(P<0.05). No deep venous thrombosis and pulmonary embolism occurred in any patients of the 4 groups. Except 1 patient who received 20 g of human albumin intravenously due to albumin of 28 g/L at 3 days postoperatively in the Group D, none patients had blood transfusion. [Conclusion] Both intravenous and topical application of tranexamic acid do significantly reduce the perioperative blood loss in fractures around the knee without increasing risk of deep vein thrombosis, and the combined intravenous and topical application get better results.
引文
[1] Sarda P, Alshryda S. Topical usage of tranexamic acid:comparative analysis in patients with bilateral total knee replacement[J].EC Orthop, 2017, 16(7):182-187.
[2] Poeran J, Rasul R, Suzuki S, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States:retrospective analysis of effectiveness and safety[J]. BMJ, 2014, 349(9):g4829.
[3]冯卫东,芦浩,王文革.双膝关节一期置换术中静脉及局部应用氨甲环酸的对照研究[J].实用骨科杂志, 2017, 23(12):1141-1143.
[4] Sarzaeem MM, Razi M, Kazemian G, et al. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty[J]. J Arthroplasty,2014, 29(8):1521-1524.
[5] Soni A, Saini R, Gulati A, et al. Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty[J]. J Arthroplasty, 2014, 29(8):1525-1527.
[6] Patel JN, Spanyer JM, Smith LS, et al. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty:a prospective randomized study[J]. J Arthroplasty, 2014, 29(8):1528-1531.
[7] Duncan CM, Gillette BP, Jacob AK, et al. Venous thromboembolism and mortality associated with tranexamic acid use during total hip and knee arthroplasty[J]. J Arthroplasty, 2015, 30(2):272-276.
[8] Nielsen CS, Jans?,?rsnes T, et al. Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty:a randomized, double-blind, placebo-controlled tria[J].JBJS, 2016, 98(10):835-841.
[9] Krauss ES, Cronin M, Suratwala SJ, et al. Use of intravenous tranexamic acid improves early ambulation after total knee arthroplasty and anterior and posterior total hip arthroplasty[J]. Am J Orthop(Belle Mead, NJ), 2017, 46(5):E314-E319.
[10] Lin SY, Chen CH, Fu YC, et al. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty[J]. J Arthroplasty,2015, 30(5):776-780.
[11] Wu Q, Zhang HA, Liu SL, et al. Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials[J]. Eur J Orthop Surg Traumatol, 2015, 25(3):525-541.
[12] Aguilera X, Martínez-Zapata MJ, Hinarejos P, et al. Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty:a multicenter, randomized,controlled trial[J]. Arch Orthop Trauma Surg, 2015, 135(7):1017-1025.
[13]赵清斌,任姜栋,张晓岗,等.氨甲环酸静脉或局部及联合应用初次单侧全髋关节置换:围置换期出血及输血率的比较[J].中国组织工程研究, 2016, 20(4):459-464.
[14] Gilbody J, Dhotar HS, Perruccio AV, et al. Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty[J]. J Arthroplasty, 2014, 29(4):681-684.
[15] Chen JY, Chin PL, Moo H, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty:a double-blinded randomised controlled noninferiority trial[J]. Knee, 2016, 23(1):152-156.
[16]郝申申,栾彦军,刘志斌,等.不同剂量氨甲环酸局部应用对全髋关节置换术后引流量的影响[J].中国医药导报, 2017, 14(30):74-77.
[2] Poeran J, Rasul R, Suzuki S, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States:retrospective analysis of effectiveness and safety[J]. BMJ, 2014, 349(9):g4829.
[3]冯卫东,芦浩,王文革.双膝关节一期置换术中静脉及局部应用氨甲环酸的对照研究[J].实用骨科杂志, 2017, 23(12):1141-1143.
[4] Sarzaeem MM, Razi M, Kazemian G, et al. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty[J]. J Arthroplasty,2014, 29(8):1521-1524.
[5] Soni A, Saini R, Gulati A, et al. Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty[J]. J Arthroplasty, 2014, 29(8):1525-1527.
[6] Patel JN, Spanyer JM, Smith LS, et al. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty:a prospective randomized study[J]. J Arthroplasty, 2014, 29(8):1528-1531.
[7] Duncan CM, Gillette BP, Jacob AK, et al. Venous thromboembolism and mortality associated with tranexamic acid use during total hip and knee arthroplasty[J]. J Arthroplasty, 2015, 30(2):272-276.
[8] Nielsen CS, Jans?,?rsnes T, et al. Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty:a randomized, double-blind, placebo-controlled tria[J].JBJS, 2016, 98(10):835-841.
[9] Krauss ES, Cronin M, Suratwala SJ, et al. Use of intravenous tranexamic acid improves early ambulation after total knee arthroplasty and anterior and posterior total hip arthroplasty[J]. Am J Orthop(Belle Mead, NJ), 2017, 46(5):E314-E319.
[10] Lin SY, Chen CH, Fu YC, et al. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty[J]. J Arthroplasty,2015, 30(5):776-780.
[11] Wu Q, Zhang HA, Liu SL, et al. Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials[J]. Eur J Orthop Surg Traumatol, 2015, 25(3):525-541.
[12] Aguilera X, Martínez-Zapata MJ, Hinarejos P, et al. Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty:a multicenter, randomized,controlled trial[J]. Arch Orthop Trauma Surg, 2015, 135(7):1017-1025.
[13]赵清斌,任姜栋,张晓岗,等.氨甲环酸静脉或局部及联合应用初次单侧全髋关节置换:围置换期出血及输血率的比较[J].中国组织工程研究, 2016, 20(4):459-464.
[14] Gilbody J, Dhotar HS, Perruccio AV, et al. Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty[J]. J Arthroplasty, 2014, 29(4):681-684.
[15] Chen JY, Chin PL, Moo H, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty:a double-blinded randomised controlled noninferiority trial[J]. Knee, 2016, 23(1):152-156.
[16]郝申申,栾彦军,刘志斌,等.不同剂量氨甲环酸局部应用对全髋关节置换术后引流量的影响[J].中国医药导报, 2017, 14(30):74-77.