安甲环酸术前应用和术前术后联合应用对膝关节置失血量及安全性影响的对照研究
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- 论文作者：李邦国 ; 刘士明 ; 徐宁 ; 田文明 ; 黑静友
- 年：2016
- 作者机构：山东省聊城市第二人民医院;
- 论文关键词：氨甲环酸 ; 膝关节置换 ; 失血量 ; 安全性
- 英文论文关键词：tranexamic acid ; The knee joint replacement ; Blood loss ; security
- 会议召开时间：2016-11-25
- 会议录名称：湖南中医药大学学报2016/专集：国际数字医学会数字中医药分会成立大会暨首届数字中医药学术交流会论文集
- 语种：中文
- 分类号：R687.4
- 学会代码：HNZY
- 会议名称：国际数字医学会数字中医药分会成立大会暨首届数字中医药学术交流会
- 会议地点：中国广东珠海
- 主办单位：国际数字医学会、Digital Chinese Medicine
- 学会名称：湖南中医药大学期刊杂志社
- 页数：2
- 文件大小：2065k
- 原文格式：D
- 会议级别：全国
摘要
目的:探讨氨甲环酸术前应用和术前术后联合应用全膝关节置换失血量的影响及安全性。方法:选择行单侧骨性关节炎行全膝关节关节置换术的95例患者,将其随机分为两组,实验组采用切开皮肤前将氨甲环酸1 g稀释于250ml生理盐水静脉滴注,切口关闭后再重复用一次。对照组切皮前将氨甲环酸2 g稀释于250ml生理盐水静脉滴注。比较两组术中出血量、术后24小时引流量、总失血量、隐性失血量及凝血酶原时间(PT)、活化部分凝血酶原时间(APPT)、纤维蛋白原(FIB)、D-二聚体和深静脉血栓(DVT)发生率。结果:实验组和对照组术中出血量分别为(262.3±22.7)ml和(291.5±22.4)ml,两组比较差异无统计学意义(P>0.05)。实验组和对照组术后24小时引流量分别为(328.5±33.5)ml和(423.3±36.7)ml,两组比较差异有统计学意义(P<0.05)。实验组和对照组总失血量分别为(970.6±26.2)ml和(1 150.3±26.7)ml,两组比较差异有统计学意义(P<0.05)。实验组和对照组隐性失血量分别为(430.5±33.5)ml和(465.3±34.7)ml,两组比较差异有统计学意义(P<0.05)。两组患者术前、松止血带时、术后3 h和术后24 h PT、APTT、FIB差异无统计学意义(P>0.05)。两组患者术后3 h和24 h D-二聚体均升高,组间比较差异无统计学意义(P>0.05)。术后两组无下肢深静脉栓塞及无肺栓塞发生。结论:全膝关节置术前术后联合使用氨甲环酸比术前一次使用降低手术失血量,并且不增加静脉血栓及肺栓塞形成的风险。
objective: to study the preoperative application of tranexamic acid and preoperative combined use of total knee replacement blood loss, postoperative effects and security. Linesmethods: unilateral osteoarthritis total knee joint replacement of the 95 patients, randomly divided into two groups, the experimental group adopted before skin incision tranexamic acid 1 g will bediluted to 250 ml saline intravenous drip, repeat with a incision was off. The control group before cutting leather tranexamic acid 2 g will be diluted to 250 ml saline intravenous drip. Compare two groupsof intraoperative blood loss, postoperative 24 hours, total blood loss and hidden blood loss and prothrombin time(PT), activated partial prothrombin time(APPT), fibrinogen(FIB), D- dimer and theincidence of deep vein thrombosis(DVT). Results: the bleeding amount of experimental group and the control group, respectively(262) 3 + 22) 7) ml(291. 5 plus or minus 22. 4) and ml, are similarbetween the two groups have no statistical significance(P > 0. 05). Of the experimental group and control group after 24 hours, respectively(328. 5-33. 5 ml) and ml(423) 3 + 36) 7), is similar betweenthe two groups have statistical significance(P < 0. 05). The experimental group and control group in total blood loss, respectively(970. 6 + /- 26. 2) and ml(1, 150. 3 + /- 26. 7) ml, are similar betweenthe two groups have statistical significance(P < 0. 05). The experimental group and control group in the hidden blood loss, respectively(430. 5-33. 5 ml) and ml(465. 3 + 34. 7), is similar between thetwo groups have statistical significance(P < 0. 05). Two groups of patients with preoperative, loose the tourniquet, postoperative 3 h and 24 h after surgery, PT, APTT, FIB has no statistically significantdifference(P > 0.05). Two groups of patients with postoperative 3 h and 24 h D- dimer are higher, comparing differences between groups have no statistical significance(P > 0.05). Two groups ofpostoperative without lower extremity deep venous thrombosis and pulmonary embolism.Conclusion: postoperative combined total knee place preoperative tranexamic acid than preoperative once usedto reduce the surgical blood loss, and does not increase the risk of venous thrombosis and pulmonary embolism formation.
objective: to study the preoperative application of tranexamic acid and preoperative combined use of total knee replacement blood loss, postoperative effects and security. Linesmethods: unilateral osteoarthritis total knee joint replacement of the 95 patients, randomly divided into two groups, the experimental group adopted before skin incision tranexamic acid 1 g will bediluted to 250 ml saline intravenous drip, repeat with a incision was off. The control group before cutting leather tranexamic acid 2 g will be diluted to 250 ml saline intravenous drip. Compare two groupsof intraoperative blood loss, postoperative 24 hours, total blood loss and hidden blood loss and prothrombin time(PT), activated partial prothrombin time(APPT), fibrinogen(FIB), D- dimer and theincidence of deep vein thrombosis(DVT). Results: the bleeding amount of experimental group and the control group, respectively(262) 3 + 22) 7) ml(291. 5 plus or minus 22. 4) and ml, are similarbetween the two groups have no statistical significance(P > 0. 05). Of the experimental group and control group after 24 hours, respectively(328. 5-33. 5 ml) and ml(423) 3 + 36) 7), is similar betweenthe two groups have statistical significance(P < 0. 05). The experimental group and control group in total blood loss, respectively(970. 6 + /- 26. 2) and ml(1, 150. 3 + /- 26. 7) ml, are similar betweenthe two groups have statistical significance(P < 0. 05). The experimental group and control group in the hidden blood loss, respectively(430. 5-33. 5 ml) and ml(465. 3 + 34. 7), is similar between thetwo groups have statistical significance(P < 0. 05). Two groups of patients with preoperative, loose the tourniquet, postoperative 3 h and 24 h after surgery, PT, APTT, FIB has no statistically significantdifference(P > 0.05). Two groups of patients with postoperative 3 h and 24 h D- dimer are higher, comparing differences between groups have no statistical significance(P > 0.05). Two groups ofpostoperative without lower extremity deep venous thrombosis and pulmonary embolism.Conclusion: postoperative combined total knee place preoperative tranexamic acid than preoperative once usedto reduce the surgical blood loss, and does not increase the risk of venous thrombosis and pulmonary embolism formation.
引文
[1]Lotke PA,Faralli VJ,Orenstein EM,et al.Blood loss aftertotal knee replacement:effects of tourniquet release and。continuous passive motion.J Bone Joint Surg Am,1991,73(7):1037-1040。
[2]Nadler S B,Hidalgo J U,Blocj T.Prediction of blood volumein normal juman adults[J].Surgery,1962,51(2):224。
[3]Sejat K R,Evans R L,Newman J H.Hidden blood loss following jip and knee artjroplasty Correct management of blood loss sjould take jidden loss into accoun[t J].Tje Journal of Bone and Joint Surgery[J].Britisj Volume,2004,86(4)
[4]Lotke PA,Faralli VJ,Orenstein EM,et al.Blood loss aftertotal knee replacement:effects of tourniquet release andcontinuous passive motion.J Bone Joint Surg Am,1991,73(7):1037-1040.
[5]Tanaka N,Sakahashi H,Sato E,et al.Timing of the administrationof tranexamic acid for maximum reduction inblood loss in arthroplasty of the knee.J Bone Joint Surg Br,2001,83(5):702-705。
[6]Maniar RN,Kumar G,Singhi T,et al.Most effective regimenof tranexamic acid in knee arthroplasty:a prospectiverandomized controlled study in 240 patients.Clin Orthop Relat Res,2012,470(9):2605-2611.
[7]safetyoftranexamic acid administration during total knee artjroplasty[J].Vox Sang,2008,95(1):
[8]Good L,Peterson E,Lisander B.Tranexamic acid deercasesexternal blood loss but not jidden blood loss in total knee replacement[J].Br J Anaestj,2003,90(5):596.。
[9]张阳,钱齐荣,吴海山,等.氨甲环酸减少全膝关节置换术失血量的Meta分析[J].中华骨科杂志.2009,29(6):524.
[10]Kagoma YK,Crowtjer MA,Doukefis J,et al.Use of antifibrinolytictjerapy to reduce transfusion in patients undergoing ortjopedicsurgery:a systematic review of randomized trials[J].Tjrombosis Res,2009,123(5):687.
[2]Nadler S B,Hidalgo J U,Blocj T.Prediction of blood volumein normal juman adults[J].Surgery,1962,51(2):224。
[3]Sejat K R,Evans R L,Newman J H.Hidden blood loss following jip and knee artjroplasty Correct management of blood loss sjould take jidden loss into accoun[t J].Tje Journal of Bone and Joint Surgery[J].Britisj Volume,2004,86(4)
[4]Lotke PA,Faralli VJ,Orenstein EM,et al.Blood loss aftertotal knee replacement:effects of tourniquet release andcontinuous passive motion.J Bone Joint Surg Am,1991,73(7):1037-1040.
[5]Tanaka N,Sakahashi H,Sato E,et al.Timing of the administrationof tranexamic acid for maximum reduction inblood loss in arthroplasty of the knee.J Bone Joint Surg Br,2001,83(5):702-705。
[6]Maniar RN,Kumar G,Singhi T,et al.Most effective regimenof tranexamic acid in knee arthroplasty:a prospectiverandomized controlled study in 240 patients.Clin Orthop Relat Res,2012,470(9):2605-2611.
[7]safetyoftranexamic acid administration during total knee artjroplasty[J].Vox Sang,2008,95(1):
[8]Good L,Peterson E,Lisander B.Tranexamic acid deercasesexternal blood loss but not jidden blood loss in total knee replacement[J].Br J Anaestj,2003,90(5):596.。
[9]张阳,钱齐荣,吴海山,等.氨甲环酸减少全膝关节置换术失血量的Meta分析[J].中华骨科杂志.2009,29(6):524.
[10]Kagoma YK,Crowtjer MA,Doukefis J,et al.Use of antifibrinolytictjerapy to reduce transfusion in patients undergoing ortjopedicsurgery:a systematic review of randomized trials[J].Tjrombosis Res,2009,123(5):687.