【摘要】：[目的]探討氨甲環(huán)酸不同給藥途徑對(duì)全膝關(guān)節(jié)置換術(shù)失血量的影響。[方法]120例擬行初次單側(cè)全膝關(guān)節(jié)置換術(shù)患者,隨機(jī)分為A、B、C、D四組,每組30例。A組在縫合關(guān)節(jié)囊后經(jīng)引流管向關(guān)節(jié)腔內(nèi)灌注溶于50ml生理鹽水的氨甲環(huán)酸(tranexamic acid,TXA)1 g;B組術(shù)前0.5 h靜滴TXA 20 mg/kg+100 ml生理鹽水;C組關(guān)閉關(guān)節(jié)囊前關(guān)節(jié)周圍軟組織注射TXA 1 g+100 ml生理鹽水;D組在縫合關(guān)節(jié)囊后向關(guān)節(jié)腔內(nèi)灌注50 ml生理鹽水。記錄圍手術(shù)期失血量、輸血量、輸血率、術(shù)后血紅蛋白濃度和術(shù)后3 h纖維蛋白原、凝血酶原時(shí)間、活化部分凝血活酶時(shí)間、皮下瘀斑、深靜脈血栓形成、患膝周徑變化率等指標(biāo)。[結(jié)果]A、B、C三組和D組兩兩比較,圍手術(shù)期失血量、輸血量和輸血率明顯減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05),A、B、C三組組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后血紅蛋白濃度A、B、C三組明顯高于D組(P0.05),A、B、C三組組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);四組患者術(shù)后3 h纖維蛋白原、凝血酶原時(shí)間和活化部分凝血活酶時(shí)間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。A、B、C三組皮下瘀斑率和患膝周徑變化率低于D組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后未發(fā)現(xiàn)下肢深靜脈血栓形成及肺梗塞、心肌梗塞、腦梗塞等血栓相關(guān)事件發(fā)生。[結(jié)論]在全膝關(guān)節(jié)置換術(shù)中應(yīng)用TXA能明顯減少圍手術(shù)期失血量,降低輸血率和輸血量,尤其是關(guān)節(jié)腔內(nèi)灌注TXA既可以減少失血又可以避免靜脈給藥可能帶來的并發(fā)癥。
[Abstract]:Objective to investigate the effect of different administration of carbamaric acid on blood loss in total knee arthroplasty. [methods] 120 patients undergoing primary unilateral total knee arthroplasty were randomly divided into four groups: group A (n = 30), group C (n = 30) and group D (n = 30). (tranexamic acid, (tranexamic acid, dissolved in 50ml saline was perfused into the joint cavity through drainage tube after the joint capsule was sutured. TXA) 1 g; In group B, TXA 20 mg/kg 100 ml saline was injected intravenously 0.5 h before operation, TXA 1 g 100 ml saline was injected into the soft tissue around the anterior joint of the joint capsule in group C, and 50 ml saline was infused into the joint cavity in group D after the joint capsule was sutured. The perioperative blood loss, transfusion rate, hemoglobin concentration, fibrin, prothrombin time, activated partial thromboplastin time, subcutaneous ecchymosis and deep venous thrombosis were recorded. The change rate of knee circumference and other indexes. [results] there were significant differences in perioperative blood loss, transfusion volume and transfusion rate between group C and group D (P 0.05). There was no significant difference among the three groups (P 0.05). The hemoglobin concentration in group A, group B and group C was significantly higher than that in group D (P 0.05). There was no significant difference in hemoglobin concentration between group B and group C (P 0.05). There was no significant difference in fibrin, prothrombin time and activated partial thromboplastin time among the four groups at 3 h after operation (P 0.05). A, B, C group was lower than D group in subcutaneous ecchymosis rate and knee circumference change rate, and there was no significant difference in fibrin, prothrombin time and activated partial thromboplastin time among the four groups at 3 h after operation (P 0.05). The difference was statistically significant (P 0.05). No deep venous thrombosis of lower extremity and thrombus related events such as pulmonary infarction, myocardial infarction and cerebral infarction were found after operation. [conclusion] the application of TXA in total knee arthroplasty can significantly reduce perioperative blood loss, blood transfusion rate and blood transfusion volume, especially intra-articular infusion of TXA can not only reduce blood loss but also avoid complications caused by intravenous administration.
【作者單位】： 內(nèi)蒙古自治區(qū)國際蒙醫(yī)醫(yī)院;
【分類號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 傅崢;張健;姚海;;氨甲環(huán)酸對(duì)全髖關(guān)節(jié)置換術(shù)隱性失血的影響[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2012年04期

2 高福強(qiáng);李子劍;張克;張洪;;人工關(guān)節(jié)置換術(shù)后隱性失血計(jì)算方法的初步探析[J];中華外科雜志;2011年12期

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張楠;翁潤民;;術(shù)中應(yīng)用氨甲環(huán)酸對(duì)全膝關(guān)節(jié)置換術(shù)后失血量的影響及安全性分析[J];創(chuàng)傷外科雜志;2017年08期

2 范亞楠;溫陽陽;張蕾蕾;李文龍;朱英杰;劉又文;;不同途徑應(yīng)用氨甲環(huán)酸對(duì)初次全髖關(guān)節(jié)置換術(shù)患者有效性及近期安全性研究[J];中國醫(yī)藥導(dǎo)報(bào);2017年21期

3 寶音;王嘎日迪;李曉東;;氨甲環(huán)酸不同給藥途徑對(duì)膝關(guān)節(jié)置換失血量的影響[J];中國矯形外科雜志;2017年12期

4 盧永偉;王銀海;顧連華;;氨甲環(huán)酸應(yīng)用于股骨粗隆間骨折圍手術(shù)期的臨床療效評(píng)價(jià)[J];中國生化藥物雜志;2017年04期

5 盧耀甲;熊傳芝;李小磊;胡翰生;陳崗;王強(qiáng);盧志華;;減少人工膝關(guān)節(jié)置換失血:兩種方法的比較[J];中國組織工程研究;2017年07期

6 張慶;盧曉棟;富學(xué)禹;賈健;;全髖關(guān)節(jié)置換術(shù)局部應(yīng)用氨甲環(huán)酸有效性及安全性Meta分析[J];中國中西醫(yī)結(jié)合外科雜志;2017年01期

7 黃維琛;郭禮躍;張有偉;吳佳恒;李仕群;;氨甲環(huán)酸對(duì)膝關(guān)節(jié)置換術(shù)后失血的影響[J];中外醫(yī)療;2017年02期

8 郭峰;;氨甲環(huán)酸對(duì)單側(cè)全髖關(guān)節(jié)置換術(shù)隱性失血的影響分析[J];中國實(shí)用醫(yī)藥;2017年01期

9 姚歡;謝錦偉;岳辰;馬俊;裴福興;;多次重復(fù)靜脈應(yīng)用氨甲環(huán)酸減少初次全髖關(guān)節(jié)置換術(shù)失血有效性與安全性的前瞻性對(duì)照研究[J];中國骨與關(guān)節(jié)雜志;2016年12期

10 梁興斌;李榮;;一期雙髖關(guān)節(jié)置換術(shù)治療青年型強(qiáng)直性脊柱炎雙髖關(guān)節(jié)骨性強(qiáng)直的療效分析[J];中國骨與關(guān)節(jié)損傷雜志;2016年12期

【二級(jí)參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 孫建輝;;加壓包扎與負(fù)壓引流預(yù)防全髖關(guān)節(jié)置換術(shù)后失血量效果比較[J];實(shí)用醫(yī)藥雜志;2010年03期

2 覃健;余存泰;徐中和;侯之啟;鄭民慶;;全髖關(guān)節(jié)及全膝關(guān)節(jié)置換術(shù)后隱性失血的臨床影響[J];中華骨科雜志;2006年05期

3 孫偉,李子榮;人工關(guān)節(jié)置換術(shù)圍手術(shù)期的血液管理[J];中華外科雜志;2004年04期

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 任明明;韓振;李敬來;程穎;吳永前;;氨甲環(huán)酸對(duì)冠狀動(dòng)脈旁路移植術(shù)后出血療效觀察[J];中國當(dāng)代醫(yī)藥;2010年19期

2 鄭祥德,馮清,張英;氨甲環(huán)酸減少開放性前列腺手術(shù)出血的臨床觀察[J];重慶醫(yī)學(xué);2005年02期

3 ;早期應(yīng)用氨甲環(huán)酸可顯著降低死亡率[J];現(xiàn)代醫(yī)院;2011年03期

4 ;早期應(yīng)用氨甲環(huán)酸可顯著降低死亡率[J];浙江中西醫(yī)結(jié)合雜志;2011年05期

5 陳艱;氨甲環(huán)酸在體外循環(huán)心臟手術(shù)中的應(yīng)用[J];江蘇醫(yī)藥;1997年03期

6 凌坤;;氨甲環(huán)酸減少開放性前列腺手術(shù)出血的臨床分析[J];醫(yī)學(xué)理論與實(shí)踐;2014年10期

7 趙e鹒，

本文編號(hào)：2493868