摘要目的 探讨氨甲环酸不同给药时间对初次单侧全髋关节置换术中及术后失血量的影响。方法 选取2018年12月至2021年2月赣州市南康区中医院骨二科行初次单侧全髋关节置换术的75 例患者的临床资料进行回顾性分析，按照用药时间分为对照组、术前组与术中组，各25 例。三组术后均予常规预防感染、抗凝及补液治疗，对照组不给予止血药物治疗；术前组于术前10 min 给予氨甲环酸1 g 静脉滴注，术后6 h 再次静脉滴注氨甲环酸1 g；术中组在手术结束前10 min 给予氨甲环酸1 g 静脉滴注，术后6 h 再给予氨甲环酸1 g 静脉滴注。比较三组术中失血量、术后引流量、隐性失血量、总失血量及输血例数，术前24 h、术后12、24、36 h 的血红蛋白（HGB）水平，术后7 d 复查患肢血管彩超统计血栓发生情况。结果 术前组与术中组术中失血量、术后引流量、隐性失血量及总失血量少于对照组，差异有统计学意义（P＜0.05），且术前组术中出血量、术后引流量少于术中组，差异有统计学意义（P＜0.05）。术前24 h，三组HGB 水平比较，差异无统计学意义（P＞0.05）。术后12、24、36 h 术前组与术中组的HGB 均高于对照组，差异有统计学意义（P＜0.05）。术前组与术中组各有1 例患者输血，输血率为4.00%（1/25），低于对照组的24.00%（6/25），差异有统计学意义（P＜0.05），且术前组术中出血量、术后引流量少于术中组，差异有统计学意义（P＜0.05）。三组术后均无下肢静脉血栓发生。结论 氨甲环酸术前、术中应用均可减少初次单侧全髋关节置换术后失血，降低输血率，不增加血栓发生风险，且术前给药疗效稍优于术中给药。
Abstract：Objective To investigate the effect of different administration times of Tranexamic Acid on blood loss during and after the initial unilateral total hip arthroplasty.Methods A retrospective analysis was performed on the clinical data of 75 patients who underwent primary unilateral total hip replacement in the Second Department of Orthopedics,Nankang District Traditional Chinese Medicine Hospital from December 2018 to February 2021.According to the time of medication,they were divided into control group,preoperative group and intraoperative group with 25 cases each.All three groups were treated with routine infection prevention,anticoagulation and fluid rehydration after operation.The control group was not given hemostatic drugs.The preoperative group was given 1 g Tranexamic Acid intravenously 10 min before surgery,and 1 g intravenous drip again 6 h after surgery.The intraoperative group was given 1 g Tranexamic Acid intravenous infusion 10 min before the end of surgery,and another 1 g tranexamic acid intravenous infusion 6 h after surgery.Intraoperative blood loss,postoperative drainage,recessive blood loss,total blood loss and the number of cases of blood transfusion,hemoglobin levels 24 h before surgery,12 h,24 h and 36 h after surgery were compared among the three groups.Seven days after the operation,the blood vessels of the affected limb were reexamined by color doppler ultrasonography.Results The intraoperative blood loss,postoperative drainage,hidden blood loss and total blood loss in the preoperative and intraoperative groups were lower than those in the control group,the differences were statistically significant(P＜0.05),and the preoperative group had less intraoperative blood loss and postoperative drainage than the intraoperative group,the differences were statistically significant(P＜0.05).24 h before operation,there was no significant difference in hemoglobin level among the three groups(P ＞0.05).The hemoglobin of preoperative group and intraoperative group was higher than that of control group 12,24,36 h after operation,and the differences were statistically significant(P＜0.05).One patient in the preoperative group and one patient in the intraoperative group received blood transfusion,and the rate of blood transfusion was 4.00%(1/25),lower than that of the control group(24.00%,6/25),the differences were statistically significant(P＜0.05).No lower limb venous thrombosis occurred in the three groups.Conclusion Preoperative and intraoperative application of Tranexamic Acid can reduce blood loss after initial unilateral total hip replacement,reduce blood transfusion rate,and do not increase the risk of thrombosis,and the effect of preoperative administration is slightly better than that of intraoperative administration.medicine.
廖章渝； 刘洪艳； 曾宪辉. 氨甲环酸不同给药时间对初次单侧全髋关节置换术中及术后失血量的影响[J]. 中国当代医药, 2021, 28(26): 108-111.
LIAO Zhang-yu； LIU Hong-yan； ZENG Xian-hui. Effect of different administration times of Tranexamic Acid on blood loss during and after the initial unilateral total hip arthroplasty. 中国当代医药, 2021, 28(26): 108-111.
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