口服与静脉氨甲环酸对膝单髁置换术失血的影响△

Effects of oral and intravenous tranexamic acid on blood loss in unicompartmental knee arthroplasty

摘要:

［目的］比较口服与静脉应用氨甲环酸（tranexamic acid, TXA）对膝关节单髁置换（unicompartmental knee arthroplas- ty, UKA）失血的影响。［方法］2020 年 6 月—2021 年 6 月本院收治的膝关节内侧单间室骨性关节炎行 UKA 术的 61 例患者纳入本研究，采用随机数字表法将患者分为两组。其中，30 例口服 TXA （口服组），31 例静脉应用 TXA （静脉组），比较两组围手术期临床和辅助检查结果。［结果］所有患者均顺利完成手术，术中未发生严重并发症。两组手术时间、切口总长度、术中失血量、术后引流量、总失血量、显性失血量、隐性失血量、输血率、下地行走时间、症状性血栓发生率、切口愈合情况、住院时间、住院费用及并发症发生率的差异均无统计学意义（P>0.05）。两组患者术后 1~3 d Hb 均显著下降（P<0.05），口服组患者 Hct 术后 1~3 d 显著下降 （P<0.05），静脉组患者 Hct 术后 1~3 d 亦下降，但差异无统计学意义 （P>0.05）。两组患者相应时间点 Hb、Hct 的差异均无统计学意义 （P>0.05）。超声检查方面，两组患者肌间静脉血栓发生率的差异无统计学意义 （P> 0.05）。［结论］口服与静脉应用氨甲环酸对膝单髁置换患者围术期失血量、输血率以及静脉血栓发生率等方面的效果相当。

Abstract:

[Objective] To compare the effects of oral versus intravenous tranexamic acid (TXA) on reducing bleeding in unicompart- mental knee arthroplasty (UKA) . [Methods] From June 2020 to June 2021, a total of 61 patients who were undergoing UKA for medial knee osteoarthritis in our hospital were enrolled into this study, and were divided into two groups by random number table method. Of them, 30 patients received oral TXA (the oral group) , while the other 31 patients had TXA intravenously in UKA (intravenous group) . The data re- garding to clinical outcome in perioperative period and blood tests were compared between the two groups. [Results] All the patients had op- erations completed smoothly with no serious complications during operation. There were no significant differences in terms of operative time, total incision length, intraoperative blood loss, postoperative drainage volume, total blood loss, dominant blood loss, hidden blood loss, blood transfusion rate, time to resume walking, incidence of symptomatic thrombosis, incision healing, hospital stay, hospitalization cost and incidence of complications between the two groups (P＞0.05) . The hemoglobin (Hb) was significantly decreased in both groups from 1 to 3 days after surgery (P＜0.05) . Likewise, the hematocrit (Hct) also declined from 1 to 3 days postoperatively, which proved statistically sig- nificant in the in the oral group (P＜0.05) , whereas not statistically significant in the intravenous group (P＞0.05) . There was no statistical significance in HB and Hct between 2 groups at any corresponding time points (P＞0.05) . In terms of ultrasound examination, there was no significant difference in the incidence of intramuscular venous thrombosis postoperatively between 2 groups (P＞0.05) . [Conclusion] Both oral administration and intravenous administration of TAX have similar effects on perioperative blood loss, transfusion rate and incidence of venous thrombosis in UKA.