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| 铁剂与氨甲环酸联合应用对单侧全膝关节置换术围手术期失血及安全性的影响 |
| Impaction of iron supplement combined with tranexamic acid on perioperative blood loss and safety of unilateral total knee arthroplasty |
| 投稿时间：2015-06-02 修订日期：2015-10-08 |
| DOI：10.3969/j.issn.1000-0399.2015.11.004 |
| 中文关键词: 氨甲环酸 铁 全膝关节置换术 失血 围手术期 |
| 英文关键词: Tranexamic Acid Iron Supplement Total Knee Arthroplasty Blood Loss Perioperative Period |
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| 中文摘要: |
| 目的 探讨联合应用铁剂和氨甲环酸对单侧全膝关节置换术(total knee arthroplasty,TKA)围手术期失血及安全性的影响。方法 选取2014年7月至2014年12月因单侧膝骨关节炎就诊并行初次TKA的患者142例,随机分为观察组76例和对照组66例。观察组于术前2周至术后2周口服补充铁剂,术中于松止血带前20 min静脉给予15 mg/kg氨甲环酸,并于切口缝合完毕后关节腔内注射氨甲环酸(1.0 g氨甲环酸+20 mL生理盐水),其余治疗方案两组相同。观察分析两组患者围手术期血红蛋白(Hb)、红细胞比容(Hct),纤维蛋白原(FIB),凝血酶原时间(PT),活化部分凝血活酶时间(APTT),手术时间,术中失血量,术后引流量,隐性失血量,总失血量,输血人数等指标。结果 两组患者术前一般资料及术前检验指标差异无统计学意义(P > 0.05);两组患者手术时间、术中失血量、术后FIB、PT、APTT比较,差异无统计学意义(P > 0.05),观察组术后1天、3天、2周时Hb及Hct均高于对照组(P < 0.05),观察组术后引流量、隐性失血量、总失血量及输血人数均少于对照组(P < 0.05)。结论 联合应用铁剂和氨甲环酸可安全、有效地减少单侧TKA围手术期的失血,促进患者术后Hb、Hct水平的恢复。 |
| 英文摘要: |
| Objective To explore and discuss the efficacy and safety of iron supplement combined with tranexamic acid in reducing perioperative blood loss of unilateral total knee arthroplasty (TKA). Methods 142 patients suffered from unilateral knee osteoarthritis and underwent primary TKA in our hospital from July to December in 2014 were enrolled in this study, then they were randomly divided into study group (76 cases) and control group (66 cases). Besides the same treatment as the control group, patients in the study group were given oral iron supplement during 2 weeks before and after the operation, and during the operation they received intra-articular injection of tranexamic acid (1.0 g) and 20 mL normal saline after suturing and intravenous tranexamic acid (15 mg/kg) at 20 min before tourniquet release. The amounts of intraoperative blood loss, hidden blood loss, total blood loss and postoperative drainage, the number of patients needing blood transfusion, the operation time, and results of blood Hb, Hct, PT, APTT, FIB of the two groups before and after the operation were recorded and analyzed. Results The differences of preoperative general conditions and examinations of patients were of no statistically significant between the two groups (P > 0.05). There was no significant difference in operation time, intraoperative blood loss and postoperative levels of PT, APTT and FIB between the two groups (P > 0.05). Results of Hb and Hct of the study group at 1 day, 3 days, 2 weeks after operation were significantly higher than those of the control group (P < 0.05), while amounts of postoperative drainage, hidden blood loss and total blood loss and number of patients needing blood transfusion in the study group were significantly less than those in the control group (P < 0.05). Conclusion The combined application of iron supplement and tranexamic acid would be safe and effective to reduce the perioperative blood loss of unilateral TKA, and further promote the recovery of blood Hb and Hct levels. |
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