氨甲环酸血液麻醉在老龄患者全膝关节置换术中的应用

摘要

Objective To investigate the efficacy and safety of tranexamic acid in the anesthesia in the aged receiving total knee arthroplasty (TKA). Methods From May 2006 to June 2009, 84 patients (41males, 43 females; aged 57 ~ 92 years, averaged 67 years; 52 with osteoarthritis, 23 with rheumatoid arthritis) who received one-side TKA were randomized into treatment group and control group (each n = 42). The patients in treatment group received 1 g of tranexamic acid diluted with 250 mL of normal saline administered intravenously, which was repeated 3 h later, and patients in control group received an equal volume of normal saline. The amounts of intraoperative blood loss, postoperative visible blood loss, the hidden blood loss, and blood transfusion, the number of patients needing blood transfusion, symptoms of deep venous thrombosis, and the values of preoperative, intraoperative, and 3 hours of postoperative D-dimer, hemoglobin, fibrinogen, prothrombin time, and activated partial thromboplastin time were recorded. Results There were no significant differences in intraoperative blood loss and the values of intraoperative and 3 hours of postoperative fibrinogen, prothrombin time, and activated partial thromboplastin time between the two groups (P> 0.05). The amounts of postoperative visible blood loss, the hidden blood loss, and blood transfusion, and the number of patients needing blood transfusion were lower, whilst the value of postoperative hemoglobin was higher in treatment group as compared with those in control group (P < 0.05). No symptoms of deep venous thrombosis was found, and no deep venous thrombosis was observed through Doppler ultrasound examination. Conclusion The application of tranexamic acid perioperatively in the aged receiving TKA could significantly decrease the amounts of blood loss and blood transfusion without increasing the risk for venous thrombosis.%目的:探讨氨甲环酸血液麻醉对老年患者全膝关节置换术围手术期失血的影响及安全性.方法:2006年5月至2009年6月行单侧全膝关节置换术的84例患者,男41例,女43例;年龄57～92岁,平均67岁.病因为骨性关节炎52例,类风湿性关节炎32例.随机分为两组,处理组将氨甲环酸1 g稀释于250 mL生理盐水后静脉点滴,3h后以相同剂量再次给药;对照组给予等量生理盐水静脉点滴.比较两组术中失血量、术后可见失血量、隐性失血量、输血量和输血人数,是否出现下肢深静脉栓塞的临床症状;术前、术中松止血带时和术后3 h检查D二聚体、纤维蛋白原、凝血酶原时间和活化的部分凝血活酶时间.结果:术中失血量两组比较差异无统计学意义(P>0.05),氨甲环酸组术后可见失血量、隐性失血量、输血量和输血人数组均明显少于对照组.且术后血红蛋白值明显高于对照组(P<0.05).同时比较两组患者术中松止血带和术后3 h时FIB、PT、APTT的差异均无统计学意义(P>0.05).无明显静脉栓塞的临床症状,术后双下肢深静脉彩色多普勒超声检查结果均未见下肢深静脉血栓形成.结论:在老年患者TKA围手术期使用氨甲环酸能明显降低患者失血量及输血量,且不增加短期静脉血栓形成的风险.