氨基己酸与氨甲环酸用于全髋关节置换术的随机对照研究

Epsilon- aminocaproic acid versus tranexamic acid used in total hip arthroplasty: a randomized controlled study

摘要:

[目的] 比较氨基己酸 (epsilon-aminocaproic acid, EACA) 与氨甲环酸 (tranexamic acid, TXA) 在全髋关节置换术 (total hip arthroplasty, THA) 中应用的效果。[方法] 2019 年 9 月—2020 年 4 月，共计 99 例拟行单侧 THA 的患者纳入本研究， 随机分为两组。其中，49 例应用 EACA，50 例应用 TXA，均为静脉和局部联合用药。比较两组患者失血指标和实验室检测指标，以及住院时间和术后并发症发生情况。[结果] 两组在估算血容量、总失血量、显性失血量、隐性失血量、术后第 1 d 和第 3 d HB、HCT、ALB、Cr、INR、APTT 和 PLT 检测值的差异均无统计学意义 (P＞0.05)。EACA 组围手术期无输血，TXA 组仅 2 例患者输血，两组间差异无统计学意义(P＞0.05)。与术后 1 d 相比，术后 3 d 两组的 HB、HCT、ALB 和 PLT 均呈下降趋势，但两时间点间的差异均无统计学意义 (P＞0.05)。 EACA 组的住院时间长于 TXA 组，但差异无统计学意义 (P＞0.05)。术后并发症方面，两组间差异无统计学意义 (P＞0.05)。[结论] EACA 与 TXA 在 THA 的应用均可有效减少血液丢失，临床效果与并发症无差异，EACA 可作为 TXA 的替代药物。

Abstract:

[Objective] To compare the outcomes of epsilon-aminocaproic acid (EACA) versus tranexamic acid (TXA) used in total hip arthroplasty (THA) . [Methods] From September 2019 to April 2020, a total of 99 patients who were undergoing unilateral primary THA were included in this study, and randomly divided into two groups. Of them, 49 patients had EACA given, while the remaining 50 pa- tients had TXA administered intravenously and locally during operation. The items related to blood loss and parameters of laboratory tests, as well as hospital stay and postoperative complications were compared between the two groups. [Results] There were no statistically sig- nificant difference between the two groups in terms of estimated blood volume, estimated blood loss and postoperative drainage volume, as well as HB, HCT, ALB, Cr, INR, APTT, and PLT at 1 and 3 days postoperatively (P＞0.05) . No one in the EACA group had blood transfu- sion during perioperative period, whereas 2 patients in the TXA group received blood transfusion, which was not statistically significant (P＞0.05) . Compared with those at 1 day postoperatively, the HB, HCT, ALB and PLT slightly declined at 3 days after operation, regard- less of that the difference between the two points was not statistically significant (P＞0.05) . The EACA group had longer hospital stays than the TXA group, but the difference was not statistically significant (P＞0.05) . In terms of postoperative complications, the difference be- tween the two groups was not statistically significant (P＞0.05) . [Conclusion] Both EACA and TXA used in THA do effectively reduce blood loss without remarkable differences in clinical outcomes and complications between them. Therefore, the EACA can be used as an alternative to TXA.