目的 探讨氨甲环酸与不同抗凝药联用对全膝关节置换术围手术期失血量的影响。 方法 纳入2014年10月至2019年10月初次行全膝关节置换术并符合标准的158例膝骨性关节炎患者，按氨甲环酸注射方法及术后使用抗凝药分为4组：A组，术中静脉注射氨甲环酸＋术后利伐沙班抗凝；B组，术中静脉注射氨甲环酸＋术后依诺肝素抗凝；C组，术中静脉＋局部注射氨甲环酸＋术后利伐沙班抗凝；D组，术中静脉＋局部注射氨甲环酸＋术后依诺肝素抗凝。各组患者一般情况、术前准备、手术方式及术后处理一致，比较其失血量、凝血功能、输血及围手术期不良事件的发生率。 结果 联合使用氨甲环酸的患者能有效控制总出血量、显性出血量、输血率及血浆D二聚体；术后使用利伐沙班或依诺肝素抗凝，出血量、输血率及围手术期不良事件发生率相当。 结论 TKA术中应用氨甲环酸静脉＋局部注射能有效减少围手术期的失血量、输血率及血浆D二聚体；术后使用利伐沙班或依诺肝素进行抗凝，两者对失血量及围手术期不良事件发生率的影响无明显差异。
Abstract
Objective To investigate the effect of tranexamic acid and different anticoagulants on blood loss during the perioperative period of total knee arthroplasty. Methods A total of 158 patients with knee osteoarthritis who underwent total knee arthroplasty (TKA) from October 2014 to October 2019 and met the criteria were enrolled. According to different tranexamic acid injection methods and postoperative use of different anticoagulants, they were divided into four group: Group A: intraoperative intravenous injection of tranexamic acid + postoperative rivaroxaban anticoagulation; Group B: intraoperative intravenous injection of tranexamic acid + postoperative enoxaparin anticoagulation; Group C: intraoperative vein injection + local injection of tranexamic acid + postoperative rivaroxaban anticoagulation; Group D: intraoperative intravenous injection + local injection of tranexamic acid + postoperative enoxaparin anticoagulation. The preoperative preparations, intraoperative and postoperative treatments of the patients in each group were the same. The general information, intraoperative conditions, blood loss, blood coagulation function, blood transfusion and incidence of perioperative adverse events were compared in the four groups. Results The combined use of tranexamic acid could further reduce total bleeding, overt bleeding, blood transfusion rate and plasma D dimerization body (P<0.05). After the use of rivaroxaban for anticoagulation, the bleeding volume, blood transfusion rate and perioperative adverse event rate were equivalent to enoxaparin. Conclusions The application of intravenous tranexamic acid combined with local injection during TKA can further effectively reduce the blood loss, transfusion rate and Plasma D dimer during the perioperative period. Rivaroxaban or enoxaparin is used for anticoagulation after operation, there is no significant difference in the blood loss and the incidence rate of perioperative adverse events.
关键词
全膝关节置换术； /
/
氨甲环酸； /
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抗凝药物； /
/
围手术期； /
/
失血量
Key words
Total knee arthroplasty; /
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Tranexamic acid; /
Anticoagulant drugs; /
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Perioperative period; /
Blood loss
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