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氨甲环酸对类风湿关节炎患者全髋关节置换围术期失血的影响
作者：魏康  沈鹏飞  彭立波  夏中玉  瞿玉兴 
单位：常州市中医医院 骨科, 江苏 常州 213000
关键词：氨甲环酸 类风湿关节炎 全髋关节置换术 失血 血栓 
分类号：R593.22;R687.4
出版年·卷·期（页码）：2017·36·第二期（192-197）
摘要：

目的：研究氨甲环酸对类风湿关节炎患者全髋关节置换围术期失血的影响。方法：回顾性分析我院2013年4月至2015年7月期间157例因类风湿关节炎（steinbrocker 3、4级）行初次全髋关节置换术患者的临床资料，其中对照组40例未使用氨甲环酸，单次给药组56例在术前20 min静脉滴注氨甲环酸15 mg·kg-1，重复给药组61例在单次给药组基础上于术后3 h再次静脉滴注氨甲环酸10 mg·kg-1。比较3组术后总失血量、输血率、深静脉血栓、肺栓塞发生率、凝血指标、术后引流量、术后血红蛋白下降值及并发症情况。结果：与对照组比较，重复给药组和单次给药组总失血量、术后引流量及术后第3天血红蛋白减少值均显著变小，差异具有统计学意义（均P<0.05）；与单次给药组比较，重复给药组术后总失血量、引流量及术后第3天血红蛋白减少值均进一步减小，差异具有统计学意义（均P<0.05）。重复给药组术后输血率明显低于对照组（P<0.05）。术后3组患者均未发生深静脉血栓及肺栓塞，且术后凝血指标组间比较均无显著差异（均P>0.05）。单次给药组7例、重复给药组5例、对照组6例出现切口并发症，组间比较差异无统计学意义（P>0.05）。结论：氨甲环酸静脉滴注可有效降低类风湿关节炎患者全髋关节置换围术期总失血量与输血率，且不增加血栓及并发症的发生。另外，术前及术后3 h重复给药作用优于术前单次使用氨甲环酸。

Objective: To study the effects of tranexamic acid on bleeding in patients with rheumatoid arthritis(RA) following total hip arthroplasty(THA). Methods: The clinical data of 157 RA patients(steinbrocker 3-4) from our hospital following primary unilateral THA from April, 2013 to July, 2015 were analyzed retrospectively. The patients were divided into three groups based on the regimen of tranexamic acid: 40 cases didn't receive tranexamic acid(control group), 56 cases received a single intravenous dosage of 15 mg·kg-1 tranexamic acid 20 min prior to operation(single group), 61 cases received an intravenous dosage of 15 mg·kg-1 preoperatively and a second dosage of 10 mg·kg-1 3 hours postoperatively(repeated group). The outcomes including total blood loss, transfusion rate, the incidence of deep vein thrombosis(DVT), and pulmonary embolism(PE), postoperative drainage, coagulative function index, postoperative hemoglobin(Hb) decline on third day postoperatively and other wound related complications in different groups were compared. Results: There were less total blood loss, postoperative drainage and Hb decline in single drug group and repeated drug group when compared with control group(all P<0.05). And the effects were better in repeated drug group than that in single group(all P<0.05). Compared with control group, the rate of transfusion requirement in repeated drug group became lower significantly(P<0.05). No episode of DVT or PE occurred in three groups. Comparison of postoperative coagulative function index among three groups had no significant differences, respectively(all P>0.05). There were 7 wound complications in sigle group, 5 in repeated group, and 6 in control group, and there were no statistical differences(P>0.05). Conclusion: Intravenous administration of tranexamic acid is effective and safe on decreasing blood loss and transfusion requirement in RA patients following THA. Compared with a single dosage of tranexamic acid preoperatively, a second dosage of tranexamic acid 3 hours postoperatively can be recommended.
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