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.
引文
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