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目的探讨氨甲环酸(TXA)减少全膝关节置换术(TKA)患者围手术期出血及对自体引流血回输和术后异体输血的影响。方法采用前瞻性随机对照方法,纳入2014年6月-2015年6月本院因膝重度骨性关节炎接受单侧人工TKA患者60名,随机分为A组(处理组:术中及术后氨甲环酸15 mg/kg静滴);B组(对照组:术中及术后同等剂量0.9%生理盐水静滴)。收集对比2组患者性别、年龄、身高、体重数据,以及术前及术后Hb、Hct,手术时长,术中出血量,术后引流量,自体引流血回输量、术后异体输血量,以及输血例数,髌上10 cm周径。用Gross方程计算患者围手术期隐性出血量及总计出血量。结果 A与B组术后引流量(m L)分别为220.37±168.6 vs 598.67±234.33;隐性出血量(m L)494.67±371.08 vs 726.75±357.48及总计出血量(m L)715.03±389.06 vs 1 325.42±422.74(均为P<0.05)。A与B组的异体输血率分别为0 vs 6.7%(2/30)。A与B组自体引流血回输量(m L)30±76.76 vs 283±111.45(P<0.05)。结论氨甲环酸可减少全膝关节置换术患者的术后出血,减少术后异体输血及自体引流血回输。
Objective To investigate the effect of tranexamic acid (TXA) on reducing perioperative bleeding in patients with total knee replacement (TKA) and on the transfusion of autologous drainage and postoperative allogeneic blood transfusion. Methods A prospective randomized controlled trial of 60 patients with unilateral TKA admitted to our hospital from June 2014 to June 2015 was randomly divided into group A (treatment group: intraoperative and postoperative Tranexamic acid 15 mg / kg intravenous infusion); Group B (control group: intraperitoneal and postoperative equivalent dose 0.9% saline infusion). The data of sex, age, height and body weight were collected and compared between the two groups before and after Hb, Hct, operation duration, intraoperative blood loss, postoperative drainage volume, autologous drainage blood transfusion, postoperative allogeneic blood transfusion volume, As well as the number of blood transfusions, 10 cm circumference on the patella. The Gross equation was used to calculate the amount of occult bleeding and the total amount of bleeding during perioperative period. Results The postoperative drainage volume (m L) in groups A and B were 220.37 ± 168.6 vs 598.67 ± 234.33 respectively; m L was 494.67 ± 371.08 vs 726.75 ± 357.48 and total blood loss was (m L) 715.03 ± 389.06 vs 1 325.42 ± 422.74 (all P <0.05). The rate of allogeneic blood transfusion in group A and B was 0 vs 6.7% (2/30), respectively. Autologous drainage volume (m L) in group A and B was 30 ± 76.76 vs 283 ± 111.45 (P <0.05). Conclusion Tranexamic acid can reduce postoperative bleeding in patients undergoing total knee arthroplasty and reduce postoperative allogeneic transfusion and autologous transfusion.