重度膝骨关节炎患者全膝关节置换术中氨甲环酸静脉注射与关节腔内注射的止血效果对比观察
摘要
目的比较关节腔内注射氨甲环酸与静脉注射氨甲环酸在重度骨关节炎患者全膝关节置换术中的止血疗效。方法选取初次单侧全膝关节关节置换术的重度骨关节炎患者128例,随机分为静脉组(止血带充气前和充气后分别静脉注射氨甲环酸1 g)与关节组(假体安装后关节腔内注射氨甲环酸3 g)。比较两组失血量、输血率、下肢深静脉血栓发生率。采用多元Logistic回归分析给药方式对术后深静脉血栓形成风险的影响。结果静脉组显性失血量、隐性失血量、总失血量、输血率、下肢深静脉血栓发生率分别为262(80～1 025) m L、173(86～860) m L、435(195～1 525) m L、7. 81%(5/64)、10. 93%(7/64);关节组分别为316(100～1 450) m L、211 (105～950) m L、527(210～1 825) m L、9. 38%(6/64)、12. 5%(8/64)。关节组总失血量、显性失血量和隐性失血量均高于静脉组(P均<0. 05)。两组输血率及下肢深静脉血栓发生率比较,P均> 0. 05。氨甲环酸给药方式不是下肢深静脉血栓形成的影响因素。结论与关节腔内注射氨甲环酸比较,静脉注射氨甲环酸能有效减少围手术期失血,同时未明显增加下肢深静脉血栓的发生。
引文
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[11] Martion JG,Cassatt KB,Kincaid-Cinnamon KA,et al. Topical administration of tranexamic acid in primary total hip total knee arthroplasty[J]. J Arthroplasty,2014,29(5):889-894.
[12]Shemshaki H,Nourian SMA,Nourian N,et al. One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty:a meta-analysis of different methods of tranexamic acid administration[J]. Arch Orthop Trauma Surg,2015,135(4):573-588.
[13]Yang ZG,Chen WP,Wu LD. Effectiveness and safety of tranecamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis[J]. J Bone Joint Surg(Am),2012,94(13):1153-1159.
[14]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.
[15] Alshryda S,Sukeik M,Sarda P,et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement[J]. Bone Joint J,2014,96-B(8):1005-1015.
[16] Gomez-Barrena E,Ortega-Andreu M,Padilla-Eguiluz NG,et al.Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement:a doubleblind,randomized,controlled,noninferiority clinical trial[J]. J Bone Joint Surg Am,2014,96(23):1937-1944.
[17]Aguilera X,Mart nez-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.
[2]Kalairajah Y,Simpson D,Cossey AJ,et al. Blood loss after total knee replacement:effects of computer-assisted surgery[J]. J Bone Joint Surg Br,2005,87(11):1480-1482.
[3]Guerin S,Collins C,Kapoor H,et al. Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty[J]. Transfus Med,2007,17(1):37-43.
[4] Jeer PJS,Cossey AJ,Keene GCR. Haemoglobin levels following nicompartmental knee arthroplasty:influence of transfusion practice and surgical approach[J]. Knee,2005,12(5):358-361.
[5]Abdel MP,Morrey BF. Implications of revision total elbow arthroplasty on blood transfusion[J]. J Shoulder Elbow Surg,2010,19(2):190-195.
[6] Gillette BP,De Simone LJ,Trousdale RT,et al. Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty[J]. Clin Orthop Relat Res,2013,471(1):150-154.
[7]Wang H,Shen B,Zeng Y. Blood loss and transfusion after topical tranexamic acid administration in primary total knee arthroplasty[J]. Orthopedics,2015,38(11):e1007-e1016.
[8]Kagoma YK,Crowther MA,Douketis J,et al. Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery:a systematic review of randomized trials[J]. Thromb Res,2009,123(5):687-696.
[9]Yang ZG,Chen WP,Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a metaanalysis[J]. J Bone Joint Surg Am,2012,94(13):1153-1159.
[10]Gillette BP,Desimone LJ,Trousdale RT,et al. Desimone low risk of thromboembolic complications with tranex-amic acid after primary total hip and knee arthroplasty[J]. Clin Orthop Relat Res,2013,471(1):150-154.
[11] Martion JG,Cassatt KB,Kincaid-Cinnamon KA,et al. Topical administration of tranexamic acid in primary total hip total knee arthroplasty[J]. J Arthroplasty,2014,29(5):889-894.
[12]Shemshaki H,Nourian SMA,Nourian N,et al. One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty:a meta-analysis of different methods of tranexamic acid administration[J]. Arch Orthop Trauma Surg,2015,135(4):573-588.
[13]Yang ZG,Chen WP,Wu LD. Effectiveness and safety of tranecamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis[J]. J Bone Joint Surg(Am),2012,94(13):1153-1159.
[14]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.
[15] Alshryda S,Sukeik M,Sarda P,et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement[J]. Bone Joint J,2014,96-B(8):1005-1015.
[16] Gomez-Barrena E,Ortega-Andreu M,Padilla-Eguiluz NG,et al.Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement:a doubleblind,randomized,controlled,noninferiority clinical trial[J]. J Bone Joint Surg Am,2014,96(23):1937-1944.
[17]Aguilera X,Mart nez-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.