氨甲环酸联合自体血回输器对人工全膝关节置换术后出血量的影响

摘要

Objective To observe the effect of tranexamic acid combined autologous blood transfusion device in preventing blood loss after total knee arthroplasty (TKA).Methods A total of 128 patients with knee osteoarthritis who underwent TKA underwent from September 2013 to September 2014 were retrospectively analyzed.According to the blood loss control method,the patients were divided into observation group and control group (each group 64 patients).Observation group were intravenous drip of 1 g tranexamic acid 15 min before loosing the toumiquets during operation,then the autologous transfusion device was used after operation;control group was only given autologous transfusion device after operation.The results of blood routine examination,blood loss and blood transfusion after TKA were compared between the two groups.Results The autologous blood transfusion volume and total drainage volume in observation group were significantly less than those in control group [(128 ± 17) ml vs (482 ±251) ml,(335 ± 179) ml vs (733 ±266) ml] (P ＜0.05);3 days after operation the red blood cell count,hemoglobin level,hematocrit in observation group were significantly higher than those in control group [(3.5 ±0.4) × 1012/L vs (3.2 ±0.4) × 1012/L,(105 ±9) g/L vs (97 ± 13)g/L,(31 ± 3)％ vs (29 ± 4) ％] (all P ＜ 0.05).Three days after operation,the total blood loss,allogeneic blood amount and transfusion rate in observation group was significantly less or lower than those in control group [(1 192 ± 197) ml vs (1 463±336) ml,(127±10) mlvs (340±18) ml,3.1％ (2/64) vs 15.6％ (10/64)] (P＜0.05).After 6 weeks of follow-up,no deep-vein thrombosis and pulmonary embolism occurred in both groups.Conclusion Tranexamic acid combined autologous blood transfusion device can reduce the dominant and hidden blood loss within 3 days after TKA and reduce the rate of blood transfusion,without increasing the incidences of deep-vein thrombosis and pulmonary embolism.%目的 观察氨甲环酸联合自体血回输器对人工全膝关节置(TKA)换术后患者出血量的影响.方法 回顾性分析山东中医药大学附属医院骨关节科2013年9月至2014年9月应用TKA治疗的128例膝关节骨关节炎患者的临床资料.根据控制术后出血方法的不同,将患者分为2组,各64例.观察组为术中松止血带前15 min,静脉滴注氨甲环酸1g,术后使用自体血回输器;对照组为术中不使用氨甲环酸,术后放置引流连接自体血回输器.分析2组TKA术后血常规的变化、失血量和输血情况.结果 观察组术后自体血回输量、总引流量低于对照组,差异有统计学意义[(128±17) ml比(482 ±251)ml、(335±179)ml比(733±266) ml,均P＜0.05];术后3d观察组红细胞、血红蛋白、血细胞比容均高于对照组,差异均有统计学意义[(3.5±0.4)×1012/L比(3.2 ±0.4)× 1012/L、(105±9)g/L比(97±13) g/L、(31±3)％比(29±4)％,均P＜0.05].术后3d观察组总失血量、异体血输血量、输血率小于对照组,差异均有统计学意义[(1 192±197) ml比(1 463 ±336)ml,(127±10) ml比(340± 18)ml,3.1％ (2/64)比15.6％(10/64),均P＜0.05].术后6周随访,观察组及对照组均未发生深静脉血栓及肺栓塞.结论 氨甲环酸联合自体血回输器可以减少TKA的显性失血量及3d内的隐性失血量,降低输血率,同时并未增加术后深静脉血栓及肺栓塞的发生率.