摘要
目的探讨氨甲环酸(tranexamic acid,TXA)对行人工全膝关节置换术(total knee arthroplasty, TKA)的肥胖膝骨关节炎患者围术期失血量的影响。方法行TKA治疗的膝骨关节炎患者136例,依据是否使用TXA及体质量指数分为肥胖TXA组40例、肥胖无TXA组33例、非肥胖TXA组34例、非肥胖无TXA组29例。肥胖TXA组、非肥胖TXA组术前静脉滴注TXA 15 mg/kg,术中假体安装完毕后经引流管向关节腔注射1 g TXA并夹闭引流管2 h;肥胖无TXA组、非肥胖无TXA组给予等量生理盐水。检测并记录4组术前及术后48 h血红蛋白(hemoglobin, Hb)及红细胞压积(hematocrit, Hct);记录手术时间,术后输血量,围术期显性失血量、隐性失血量及总失血量;记录围术期下肢静脉血栓及肺栓塞发生情况。结果非肥胖TXA组术后输血量较非肥胖无TXA组少(P<0.05),肥胖TXA组较肥胖无TXA组少(P<0.05),肥胖TXA组与非肥胖TXA组比较差异无统计学意义(P>0.05);非肥胖TXA组、非肥胖无TXA组手术时间均较肥胖TXA组、肥胖无TXA组短(P<0.05),非肥胖TXA组与非肥胖无TXA组、非肥胖无TXA组与肥胖无TXA组比较差异无统计学意义(P>0.05)。非肥胖TXA组围术期总失血量[(1 156.39±271.24)mL]、隐性失血量[(904.67±319.68)mL]均较非肥胖无TXA组[(1 349.99±326.47)、(1 034.59±325.79)mL]少(P<0.05),肥胖TXA组总失血量[(932.84±345.07)mL]、隐性失血量[(700.34±329.35)mL]均较肥胖无TXA组[(1 149.13±334.86)、(941.16±345.69)mL]少(P<0.05),肥胖TXA组总失血量、隐性失血量较非肥胖TXA组少(P<0.05);4组显性失血量比较差异无统计学意义(P>0.05)。4组术前Hb、Hct比较差异无统计学意义(P>0.05),非肥胖TXA组术后48 h Hb [(100.53±14.35)g/L]、Hct[(29.66±3.85)%]均较非肥胖无TXA组[(88.75±13.03)g/L、(26.59±3.78)%]高(P<0.05),肥胖TXA组术后48 h Hb[(109.53±12.67)g/L]、Hct [(32.43±3.82)%]均较非肥胖无TXA组[(96.00±12.08)g/L、(29.01±3.42)%]高(P<0.05),肥胖TXA组术后48 h Hb、Hct高于非肥胖TXA组(P<0.05)。4组围术期均无下肢静脉血栓形成、肺栓塞病例。结论肥胖、非肥胖的膝骨关节炎患者应用TXA均可减少TKA围术期失血量,肥胖患者应用效果更显著。
Objective To investigate the efficacy of tranexamic acid(TXA)on perioperative blood loss during total knee arthroplasty in obese knee osteoarthritis patients.Methods Totally 136 knee osteoarthritis patients underwent total knee arthroplasty.According to the use of TXA and body mass index(BMI),these patients were divided into obese TXA group(n=40),obese without TXA group(n=33),non-obese TXA group(n=34),and non-obese without TXA group(n=29).Obese TXA group and non-obese TXA group were intravenously infused with TXA 15 mg/kg before operation,1 g of TXA was injected into the joint cavity through the drainage tube after the prosthesis was installed,and the drainage tube was clamped for 2 h.Obese without TXA group and non-obese without TXA group were given equivalent normal saline.The levels of hemoglobin(Hb)and hematocrit(Hct)before and 48 h after operation,the operation lasting time,the postoperative blood infusion,perioperative dominant blood loss,hidden blood loss,and total blood loss were recorded in four groups.The perioperative venous thrombosis in lower extremity and pulmonary embolism were observed.Results The blood infusion was less in non-obese TXA group than that in non-obese without TXA group(P<0.05),less in obese TXA group than that in obese without TXA group(P<0.05),and showed no significant difference between obese TXA group and non-obese TXA group(P>0.05).The operation lasting time was shorter in non-obese TXA group and non-obese without TXA group than that in obese TXA group and obese without TXA group(P<0.05),and showed no significant difference between non-obese TXA group and non-obese without TXA group as well as between obese without TXA group and non-obese without TXA group(P>0.05).The total blood loss and the hidden blood loss were less in non-obese TXA group((1156.39±271.24),(904.67±319.68)mL)than those in non-obese without TXA group((1349.99±326.47),(1034.59±325.79)mL)(P<0.05),less in obese TXA group((932.84±345.07),(700.34±329.35)mL)than those in obese without TXA group((1149.13±334.86),(941.16±345.69)mL)(P<0.05),and less in obese TXA group than those in non-obese TXA group(P<0.05).There was no significant difference in the dominant blood loss among four groups(P>0.05).The preoperative Hb and Hct levels showed no significant differences among four groups(P>0.05).The levels of Hb and Hct were higher in non-obese TXA group((100.53±14.35)g/L,(29.66±3.85)%)than those in non-obese without TXA group((88.75±13.03)g/L,(26.59±3.78)%)(P<0.05),in obese TXA group((109.53±12.67)g/L,(32.43±3.82)%)than those in non-obese without TXA group((96.00±12.08)g/L,(29.01±3.42)%)(P<0.05),and in obese TXA group than those in non-obese TXA group 48 hafter operation(P<0.05).No perioperative venous thrombosis or pulmonary embolism was found in four groups.Conclusion TXA can reduce perioperative blood loss in obese and non-obese knee osteoarthritis patients in total knee arthroplasty,and the effect on obese patients is more significant.
作者
刘子歌
张晨
宋国瑞
李燕
陈德胜
LIU Zige;ZHANG Chen;SONG Guorui;LI Yan;CHEN Desheng(School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Basic Medical College,Ningxia Medical University,Yinchuan 750004,China;Department of Orthopedics,General Hospital of Ningxia Medical University,Yinchuan 750004,China)
出处
《中华实用诊断与治疗杂志》
2020年第7期731-734,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金(81760405)
国家自然科学基金(81760395)
国家自然科学基金(81560364)
宁夏自然科学基金重点项目(2018AAC02013)
宁夏医科大学校级课题重点项目(XZ2018014)。
