不同剂量氨甲环酸关节腔内注射预防全髋关节置换术术后失血的临床疗效观察
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摘要
目的:观察不同剂量氨甲环酸关节腔内注射预防全髋关节置换术术后失血的临床疗效。方法:选取2016年1月-2018年1月笔者所在医院行全髋关节置换术的99例患者,随机分为高剂量组(32例)、低剂量组(33例)及对照组(34例),高剂量组给予2 g氨甲环酸、低剂量组给予1 g氨甲环酸、对照组予等量0.9%氯化钠注射液关节腔内注射,观察三组患者术后1 d的血红蛋白浓度、失血量、凝血功能、住院时间及并发症发生情况。结果:高剂量组患者的血红蛋白浓度明显高于低剂量组,且低剂量组高于对照组,差异均有统计学意义(P<0.05)。高剂量组失血量均明显少于低剂量组及对照组,且低剂量组少于对照组,差异均有统计学意义(P<0.05)。高剂量组住院时间短于低剂量组及对照组,且低剂量组短于对照组,差异均有统计学意义(P<0.05)。三组患者均无肺栓塞、下肢深静脉血栓等并发症发生,且术后1 d三组患者凝血功能指标比较,差异无统计学意义(P>0.05)。结论:高剂量氨甲环酸关节腔注射可有效预防全髋关节置换术术后出血,减少输血量,缩短住院时间,且氨甲环酸关节腔注射不影响患者凝血功能,安全有效。
Objective:To observe the clinical effect of intra-articular injection of different doses of Tranexamic Acid in preventing blood loss after total hip replacement.Method:A total of 99 patients undergoing total hip arthroplasty in our hospital from January 2016 to January 2018 were randomly divided into high dose group(32 cases),low dose group(33 cases)and control group(34 cases).High dose group was given 2 g Tranexamic Acid,low dose group was given 1 g Tranexamic Acid,and control group was given the same amount of 0.9% sodium chloride injection intra-articular injection.The hemoglobin concentration 1 day after the operation,blood loss,coagulation function,hospital stay and complications of the three groups were observed.Result:The hemoglobin concentration of patients in the high dose group was significantly higher than that in the low dose group,and that in the low dose group was higher than in the control group,the differences were statistically significant(P<0.05).The blood loss in the high dose group was significantly less than that in the low dose group and the control group,and that in the low dose group was less than that in control group,the differences were statistically significant(P<0.05).The hospital stay in high dose group was shorter than that in low dose group and control group,and that in low dose group was less than that in control group,the differences were statistically significant(P<0.05).There were no complications such as pulmonary embolism and deep venous thrombosis of lower limbs in all three groups.There was no significant difference in coagulation function between the three groups one day after operation,there was no statistically significant difference(P>0.05).Conclusion:High dose of Tranexamic Acid intra-articular injection can effectively prevent bleeding after total hip arthroplasty,reduce blood transfusion,shorten hospitalization days,and Tranexamic Acid intra-articular injection does not affect the coagulation function of patients,safe and effective.
Objective:To observe the clinical effect of intra-articular injection of different doses of Tranexamic Acid in preventing blood loss after total hip replacement.Method:A total of 99 patients undergoing total hip arthroplasty in our hospital from January 2016 to January 2018 were randomly divided into high dose group(32 cases),low dose group(33 cases)and control group(34 cases).High dose group was given 2 g Tranexamic Acid,low dose group was given 1 g Tranexamic Acid,and control group was given the same amount of 0.9% sodium chloride injection intra-articular injection.The hemoglobin concentration 1 day after the operation,blood loss,coagulation function,hospital stay and complications of the three groups were observed.Result:The hemoglobin concentration of patients in the high dose group was significantly higher than that in the low dose group,and that in the low dose group was higher than in the control group,the differences were statistically significant(P<0.05).The blood loss in the high dose group was significantly less than that in the low dose group and the control group,and that in the low dose group was less than that in control group,the differences were statistically significant(P<0.05).The hospital stay in high dose group was shorter than that in low dose group and control group,and that in low dose group was less than that in control group,the differences were statistically significant(P<0.05).There were no complications such as pulmonary embolism and deep venous thrombosis of lower limbs in all three groups.There was no significant difference in coagulation function between the three groups one day after operation,there was no statistically significant difference(P>0.05).Conclusion:High dose of Tranexamic Acid intra-articular injection can effectively prevent bleeding after total hip arthroplasty,reduce blood transfusion,shorten hospitalization days,and Tranexamic Acid intra-articular injection does not affect the coagulation function of patients,safe and effective.
引文
[1]张弛.全髋关节置换术相关安全性的临床研究[D].郑州:郑州大学,2016.
[2]Alshryda S,Mason J,Sarda P,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total hip replacement:a randomized controlled trial(TRANX-H)[J].J Bone Joint Surg Am,2013,95(21):1969-1974.
[3]王浩洋,康鹏德,杨静,等.氨甲环酸减少全髋关节翻修术围手术期失血的安全性及有效性研究[J/OL].中华关节外科杂志:电子版,2013,7(5):603-608.
[4]李征,安帅,周萌,等.全髋或半髋关节置换术治疗老年股骨颈骨折的失血量对比研究[J].北京医学,2015,37(11):1028-1030.
[5]叶一林,柴卫兵,卢宏章,等.人工膝关节置换术中静脉注射氨甲环酸对减少术后失血的临床观察[J].中国矫形外科杂志,2016,24(21):1964-1967.
[6]刘舰.氨甲环酸不同用法在初次全髋关节置换围手术期临床疗效比较分析[D].长春:吉林大学,2017.
[7]秦建华,张雪蓉,朱钧.氨甲环酸对先心病体外循环手术患儿凝血功能的影响[J].海南医学,2015,26(9):1345-1346.
[8]谢锦伟,岳辰,裴福兴.氨甲环酸在全髋关节置换术中的有效性与安全性研究进展[J].中国矫形外科杂志,2014,22(20):1856-1860.
[9]席少华,周朝波,赵桂林.氨甲环酸在全膝关节置换术中局部应用和静脉应用的止血效果比较[J].实用药物与临床,2015,18(4):481-484.
[10]严俊,黄彰,潘政军,等.小剂量氨甲环酸对全膝关节置换术后出血的临床研究[J].临床医学,2015,35(3):1-3.
[11]姬健钧,杨自权,赵永亮,等.氨甲环酸在全膝关节置换术中应用策略的研究进展[J].中国骨伤,2015,35(1):60-63.
[12]段国庆,任春凤.不同剂量氨甲环酸局部应用并不放置引流减少全膝关节置换后失血[J].中国组织工程研究,2017,21(35):5583-5588.
[2]Alshryda S,Mason J,Sarda P,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total hip replacement:a randomized controlled trial(TRANX-H)[J].J Bone Joint Surg Am,2013,95(21):1969-1974.
[3]王浩洋,康鹏德,杨静,等.氨甲环酸减少全髋关节翻修术围手术期失血的安全性及有效性研究[J/OL].中华关节外科杂志:电子版,2013,7(5):603-608.
[4]李征,安帅,周萌,等.全髋或半髋关节置换术治疗老年股骨颈骨折的失血量对比研究[J].北京医学,2015,37(11):1028-1030.
[5]叶一林,柴卫兵,卢宏章,等.人工膝关节置换术中静脉注射氨甲环酸对减少术后失血的临床观察[J].中国矫形外科杂志,2016,24(21):1964-1967.
[6]刘舰.氨甲环酸不同用法在初次全髋关节置换围手术期临床疗效比较分析[D].长春:吉林大学,2017.
[7]秦建华,张雪蓉,朱钧.氨甲环酸对先心病体外循环手术患儿凝血功能的影响[J].海南医学,2015,26(9):1345-1346.
[8]谢锦伟,岳辰,裴福兴.氨甲环酸在全髋关节置换术中的有效性与安全性研究进展[J].中国矫形外科杂志,2014,22(20):1856-1860.
[9]席少华,周朝波,赵桂林.氨甲环酸在全膝关节置换术中局部应用和静脉应用的止血效果比较[J].实用药物与临床,2015,18(4):481-484.
[10]严俊,黄彰,潘政军,等.小剂量氨甲环酸对全膝关节置换术后出血的临床研究[J].临床医学,2015,35(3):1-3.
[11]姬健钧,杨自权,赵永亮,等.氨甲环酸在全膝关节置换术中应用策略的研究进展[J].中国骨伤,2015,35(1):60-63.
[12]段国庆,任春凤.不同剂量氨甲环酸局部应用并不放置引流减少全膝关节置换后失血[J].中国组织工程研究,2017,21(35):5583-5588.