不同剂量氨甲环酸局部应用对全髋关节置换术后引流量的影响

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摘要目的观察不同剂量氨甲环酸（TXA）局部应用对全髋关节置换（THA）术后引流量的影响。方法将2016年1~12月于延安大学附属医院行初次单侧THA的75例患者采用随机数字表法分为三组，每组25例。A组于缝皮后经引流管逆行注入TXA 1.0 g（生理盐水：100 mL）。B组、C组分别以同样的方法注入TXA 2.0 g（生理盐水：100 mL）、3.0 g（生理盐水：100 mL）。主要观察项目为术后引流量、术后第3天血红蛋白（Hb）、输血人数。次要观察项目为手术时间、术中失血量、术后第3天凝血酶原时间、术后第3天活化部分凝血酶时间及肺栓塞、下肢深静脉血栓、感染的发生率。结果三组一般资料比较，差异无统计学意义（P > 0.05）。主要观察项目中，术后引流量依次递减，Ａ组显著大于Ｂ组、Ｃ组（P < 0.05），而Ｂ组与Ｃ组间差异无统计学意义（P > 0.05）。术后第3天Hb依次递增，Ａ组显著低于Ｂ组、Ｃ组（P < 0.05），而Ｂ组与Ｃ组间差异无统计学意义（P > 0.05）。输血率方面，三组间差异无统计学意义（P > 0.05）。三组次要观察项目间比较，差异均无统计学意义（P > 0.05）。结论 TXA局部应用2.0 g减少THA术后引流量的作用优于1.0 g，而与3.0 g相似，故推荐2.0 g TXA局部应用作为减少THA术后引流量的合适剂量。

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	郝申申栾彦军刘志斌王飞刘延雄刘军

关键词 ：氨甲环酸, 经引流管逆行注入, 全髋关节置换术, 术后引流量

Abstract：Objective To observe the effect of different dose of tranexamic acid (TXA) topical application on the postoperative drainage of total hip arthroplasty (THA). Methods 75 patients with primary unilateral THA from January to December 2016 were divided into three groups random number table, 25 patients in each group. The group A was treated by retrograde injection of 1.0 g (NS: 100 mL) TXA via the drainage tube when incision was sewed up. Group B and group C were injected with 2.0 g (NS: 100 mL) TXA and 3.0 g (NS: 100 mL) TXA in the same way, respectively. The main observation items were postoperative drainage volume, hemoglobin (Hb) of the third day after operation and number of blood transfusion. The secondary items included operation time, intraoperative blood loss, prothrombin time and activated partial thromboplastin time of the third day after surgery, number of pulmonary embolism, number of deep vein thrombosis and number of infections. Results There was no significant difference among the three groups in the base data (P > 0.05). In the main observation items, the postoperative drainage volume decreased successively; the group A was significantly larger than the group B and the group C respectively (P < 0.05), while the difference between the group B and the group C was not statistically significant (P > 0.05). The Hb of the third day after operation increased successively; group A was significantly lower than group B and group C respectively (P < 0.05), while there was no significant difference between group B and group C (P > 0.05). The incidence of blood transfusion was not statistically significant among the three groups (P > 0.05). There was no significant difference among the three groups in the secondary observation index (P > 0.05). Conclusion The topical application of 2.0 g TXA is superior to 1.0 g TXA in reducing the postoperative drainage volume of THA, but similar to that of 3.0 g TXA. Therefore, it was recommended that 2.0 g TXA is used as a proper dose to decrease the postoperative drainage volume of THA.

Key words： Tranexamic acid Retrograde injection via drainage tube Total hip arthroplasty Postoperative drainage volume

基金资助:陕西省社会发展科技攻关项目（2015SF115）；
陕西省延安市科技惠民计划项目（2016HM-10-03）。

通讯作者: 栾彦军（1981-），男，陕西子长人，副主任医师，硕士；研究方向：关节外科。刘志斌（1967-），男，陕西延长人，主任医师；研究方向：关节与脊柱外科。

作者简介: 郝申申（1988-），男，河南宝丰人，延安大学2015级骨外科学专业在读硕士研究生；研究方向：关节与脊柱外科。

引用本文:

郝申申栾彦军刘志斌王飞刘延雄刘军. 不同剂量氨甲环酸局部应用对全髋关节置换术后引流量的影响[J]. 中国医药导报, 2017, 14(30): 74-77.
HAO Shenshen LUAN Yanjun LIU Zhibin WANG Fei LIU Yanxiong LIU Jun. Effect of different dose of tranexamic acid local application on the postoperative drainage of total hip arthroplasty. 中国医药导报, 2017, 14(30): 74-77.

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