[1]白伟侠,牛映祯,马红瑞,等.氨甲环酸在初次膝关节置换中的应用研究[J].中华老年骨科与康复电子杂志,2017,(06):362-366.[doi:10.3877/cma.j.issn.2096-0263.2017.06.009]
　Bai Weixia,Niu Yingzhen,Ma Hongrui,et al.Application of ammoniacal acid in primary total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(06):362-366.[doi:10.3877/cma.j.issn.2096-0263.2017.06.009]
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氨甲环酸在初次膝关节置换中的应用研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年06期
页码:
362-366
栏目:
论著
出版日期:
2017-11-27

文章信息/Info

Title:
Application of ammoniacal acid in primary total knee arthroplasty
作者:
白伟侠; 牛映祯 ; 马红瑞; 卢连君; 何丽英; 秦迪;  王飞
050051 石家庄，河北医科大学第三医院关节外科 1；050700 河北省新乐市医院麻醉科 2
Author(s):
Bai Weixia1;  Niu Yingzhen1;  Ma Hongrui2;  Lu Lianjun1;  He Liying1;  Qin Di1;  Wang Fei1.
1Department of Joint, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; 2Department of Anesthesiology, Hospital of Xinle, Xinle 050700, China
关键词:
关节成形术; 置换; 膝;  氨甲环酸;  血栓形成;  出血量
Keywords:
Arthroplasty;  replacement;  knee;  Tranexamic acid;  Thrombosis;  Bleeding volume
DOI:
10.3877/cma.j.issn.2096-0263.2017.06.009
文献标志码:
A
摘要:
目的 评估两种不同氨甲环酸给药方式在初次膝关节置换中的应用效果。方法 前瞻性收集 2014年 1月至 2015年 12月河北医科大学第三医院关节科收治的初次膝关节置换术患者 98例，采用随机数字表法将其分为两组，实验组患者（49例）于切皮前 0.5 h静脉滴注 15 mg/kg氨甲环酸，术中关节腔注射 1 mg 氨甲环酸，术后 3 h 滴注 10 mg/kg 氨甲环酸。对照组患者（49 例）于切皮前静脉滴注 15 mg/kg氨甲环酸，术中关节腔注射 1 mg氨甲环酸患者。分别于术后 24 h评估两组患者的出血量、输血量以及血红蛋白、血细胞容积变化情况。结果 98例患者均获得完整随访，随访时间（10±3）d。术后实验组出血量（176±34 ml）低于对照组（212±40 ml，t=2.972，P＜0.05）。实验组术后血红蛋白含量（109±10 g/L）高于对照组（107±8 g/L，t=2.681，P＜0.05）。实验组的住院天数（6.0±2.2 d）低于对照组（8.4±3.0 d，t=2.641，P＜0.05）。结论 初次膝关节置换术后静脉重复给药联合关节腔内注射氨甲环酸可减少出血量，缩短住院时间。
Abstract:
Objective To evaluate the effect of different ways of tranexamic acid (TXA) on primary total knee arthroplasty (TKA). Methods A prospective study was performed in 98 patients of TKA treated in the Joint department of the third Hospital of Hebei Medical University from January 2014 to December 2015, patients were divided into two groups randomly. The treatment group (n=49) was given 15 mg/kg TXA intravenous injection 0.5 h before incision, 1.0 g TXA intraarticular injection intraoperatively, 10 mg/kg TXA intravenous injection 3 hours post-operatively. The control group (n=49) was given 15 mg/kg TXA intravenous injection before incision, 1.0 g TXA intraarticular injection intraoperatively. The bleeding volume, transfusion volume as well as variation of hemoglobin and blood volume within 24 h after surgery were compared between two groups. Results All patients were followed-up with an average of 10±3 d. There was no deep venous thrombosis (DVT) among all patients after surgery. The blood loss of the experimental group (176± 34 ml) were significantly lower than the control group (212±40 ml) after surgery (t=2.972, P<0.05). The hemoglobin content of the experimental group (109±10 g/L) were significantly higher than the control group (107±8 g/L) after surgery (t=2.681, P<0.05). The mean hospital stay of the experimental group (6.0±2.2 d) were significantly higher than the control group (8.4±3.0 d, t=2.641, P<0.05). Conclusions Postoperative bleeding volume and hospital stay was significantly decreased in primary TKA with reduplicative intravenous administration combined with intraarticular injection of TXA.

参考文献/References:

1 Markel DC, Allen MW, Hughes RE, et al. Quality initiative programs can decrease total joint arthroplasty transfusion Rates- A multicenter study using the MARCQI total joint registry database [J]. J Arthroplasty, 2017, 32(11): 3292-3297.
2 Mayer C, Franz A, Harmsen JF, et al. Soft-tissue damage during total knee arthroplasty: Focus on tourniquet-induced metabolic and Ionic muscle impairment [J]. J Orthop, 2017, 14(3): 347-353.
3 丁敏, 祁伟, 刘方刚, 等. 氨甲环酸在人工全髋关节置换术中局部应用的疗效分析 [J]. 医学研究生学报, 2014, 27(08): 833-835.
4 Rong GX, Shen CL, Gui BJ, et al. Comparison of tranexamic acid pharmacokinetics after intra-articular and intravenous administration in rabbits [J]. Pak J Pharm Sci, 2017, 30(4): 1309-1316.
5 蒋忠, 沈伟中, 骆园. UKA 与 TKA 治疗膝关节内侧单间室骨性关节炎初期疗效比较 [J]. 中国骨与关节损伤杂志, 2015, 30(4): 353- 356.
6 Wang Z, Shen X. The efficacy of combined intra- articular and intravenous tranexamic acid for blood loss in primary total knee arthroplasty: A meta-analysis [J]. Medicine, 2017, 96(42): e8123.
7 闵令田, 翁文杰, 邱勇, 等. 关节腔内灌注氨甲环酸降低全膝关节置换手术出血的前瞻性随机对照研究 [J]. 中华关节外科杂志:电子版, 2014, 8(4): 482-486.
8 Steinhaus ME, Christ AB, Cross MB. Total knee arthroplasty for knee osteoarthritis: support for a foregone conclusion? [J]. HSS J, 2017, 13(2): 207-210.
9 Voorn VMA, Marang- Van De Mheen PJ, Van Der Hout A, et al. Hospital variation in allogeneic transfusion and extended length of stay in primary elective hip and knee arthroplasty: a cross-sectional study [J]. BMJ Open, 2017, 7(7): e014143.
10 张朋, 陈勇忠, 杨良锁, 等. 不同时间给予氨甲环酸对减少全髋关节置换术中术后失血的影响 [J]. 临床骨科杂志, 2014, 17(4): 396- 400.
11 Boese CK, Centeno L, Walters RW. Blood conservation using tranexamic acid is not superior to Epsilon-Aminocaproic acid after total knee arthroplasty [J]. J Bone Joint SurgAm, 2017, 99(19): 1621- 1628.
12 岳辰, 康鹏德, 沈彬, 等. 氨甲环酸用于首次髋关节置换术的系统评价和 Meta分析 [J]. 中国矫形外科杂志, 2013, 21(12): 1167-1172.
13 马骏, 李国庆, 曹力. 全膝关节置换术中不同压力止血带对术后肿胀及疼痛影响的临床研究 [J]. 中国矫形外科杂志, 2013, 21(13): 1297-1301.
14 Wang J, Wang Q, Zhang X, et al. Intra-articular Application is More Effective Than Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial [J]. J Arthroplasty, 2017, 32(11): 3385-3389.
15 马金辉, 孙伟, 高福强, 等. 关节腔注射氨甲环酸单侧全膝关节置换者的失血量及肢体周径变化:随机对照 [J]. 中国组织工程研究, 2014, 18(35): 5577-5582.
16 岳辰, 马俊, 杨沛青, 等. 氨甲环酸减少同期双侧全髋置换围术期失血有效性及安全性研究 [J]. 中国矫形外科杂志, 2014, 22(10): 865- 869.

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备注/Memo

备注/Memo:
基金项目：卫生部医药卫生科技项目（13010520140799）
更新日期/Last Update: 2017-11-28