静脉联合局部的应用氨甲环酸对单侧全膝关节置换围术期出血量的影响及安全性评估.docVIP

静脉联合局部的应用氨甲环酸对单侧全膝关节置换围术期出血量的影响及安全性评估 　　【摘 要】目的：观察静脉联合局部应用氨甲环酸对单侧全膝关节置换术术中、术后出血量、输血量、血红蛋白值及凝血功能的影响并对其安全性加以评估。方法：将86例初次行单侧全膝关节置换术的患者随机分为治疗组和对照组，每组43例。治疗组在假体安装完成缝合开始时，给1 g氨甲环酸配入100 mL生理盐水静脉滴注；膝关节假体安装完缝合关节囊后，再给1 g氨甲环酸稀释于50 mL生理盐水注入关节腔内；术后3 h再次静脉滴入1 g氨甲环酸。对照组给予等量生理盐水静脉滴注。比较两组术中出血量、术后可见失血量、输血量、输血人数及术后血红蛋白值、术后纤维蛋白原、凝血酶原时间等检测结果；术后观察患者是否出现下肢深静脉栓塞的临床症状，术后1周行常规下肢深静脉多普勒超声检查。结果：两组术中失血量比较，差异无统计学意义（P 0.05），但术后失血量、输血量、输血人数比较，治疗组均明显低于对照组（P 0.05）；术后1周下肢深静脉血栓形成率比较，差异无统计学意义（P 0.05）。结论：局部及联合静脉应用氨甲环酸在全膝关节置换术中及术后，能明显降低患者的术后失血量及输血量等，具有良好的止血效果且不增加静脉血栓形成的风险。 　　【关键词】 全膝关节置换术；静脉；凝血时间；氨甲环酸；失血量 　　doi：10.3969/j.issn.2095-4174.2015.10.003 　　【ABSTRACT】Objective：To explore the effect of intravenous and topical application of tranexamic acid on amount of bleeding and blood transfusion，content of hemoglobin and blood coagulation in the perioperative period of unilateral total knee replacement and its safety evaluation.Methods：86 patients who would undergo unilateral total knee replacement were randomly divided into a treatment group and a control group，43 cases in each.Patients of the treatment group were given intravenous drip of tranexamic acid（1 g） and physiological saline （100 mL） while stitching after prosthesis installation and given tranexamic acid（1 g） and physiological saline （50 mL） into the joint cavity after suturing the joint capsule.After 3 hours of replacement，they were again given intravenous infusion of 1 g tranexamic acid.Patients in the control group were given the same amount of normal saline.Compared intraoperative blood loss，postoperative blood loss，blood transfusion，blood donors，postoperative hemoglobin，postoperative fibrinogen and prothrombin time of the two groups.Postoperative observation of patients was made for the possibility of deep venous embolism in lower limb.One week after operation，Doppler ultrasound for the deep vein was made.Results：The difference of blood loss between the two groups was not statistically significant（P 0.05），but the postoperative blood lo