评估止血敏在TKA术后减少失血量的作用

2012-02-23 文章来源：www.aaos.org 点击量：1745 　　我要说

翻译：广东省人民医院骨科，广东省医学科学院　林子洪，郑秋坚

前言：

　　已有大量研究报道全膝关节表面置换术(total knee arthroplasty, TKA) 术中或术后使用止血敏 (tranexamic acid, TA)可以显著地减少围手术期出血量和异体输血量，但以上多数研究均存在一个明显缺陷，即在术前回收自体血，尤其在该流程没标准化的情况下，则影响了根据血红蛋白下降水平计算失血量的准确性。本研究的目的是评估TA减少失血量和输血机率的效果.

方法：

　　本研究回顾了由一位医生连续完成的80例双侧TKA，没有一例术前回收自体血。头40例病人未行TA治疗，后40例病人在第一侧膝关节置换止血带放气前约10分钟一次性注射TA(20mg/kg)，然后记录血红蛋白水平、血球压积、输血量、术后麻醉药用量和住院时间

结果：

　　两组的临床数据相似。与对照组相比，TA治疗组依据术后第二天的血红蛋白下降水平计算出的失血量少(4.55 vs 5.37 g/dl)，而异体输血量的情况却相反（8％ vs 52％）。术后血红蛋白水平越高的患者，住院时间更短，止痛药用量更好少，出院时膝关节活动度更好。

讨论与结论：

　　TKA患者术中使用TA能减少术后出血量，改善一些预后的指标，而不增加血栓形成的风险。

INTRODUCTION

Numerous studies have suggested that the use of tranexamic acid (TA) during or prior to total knee arthroplasty (TKA) significantly reduces perioperative blood loss and allogenic transfusion requirements. One notable weakness in most of these studies is the collection of autologous blood prior to surgery which could be described as a confounding factor in determining blood loss based on hemoglobin drop, especially if protocol for blood collection is not standardized. The aim of the study was to determine the efficacy of TA in reducing blood loss and transfusion.
METHODS

We retrospectively identified 80 consecutive patients who underwent bilateral total knee arthroplasty by a single surgeon. None of these patients donated autologous blood prior to surgery. The first 40 patients did not receive TA while the second group of 40 patients received a single dose (20mg/kg) of TA approximately 10 minutes prior to deflation of tourniquet of the first knee. Patients’ charts were reviewed to identify detailed data including the hemoglobin level, hematocrit, transfusions, postoperative narcotic use and length of hospital stay.
RESULTS

Both groups of patients were largely similar based on demographic data. Blood loss, as determined by the hemoglobin drop on postoperative day 2, among patients who received TA was less than that of patients who did not receive TA (4.55 vs 5.37 g/dl.) In addition, 52% of control patients versus 8% of study patients required allogenic blood transfusion. Finally, study patients had significantly higher postoperative hemaglobins, shorter LOS, less analgesic requirements and better discharge ROM.
DISCUSSION AND CONCLUSION

It appears that use of TA with TKA does reduce postoperative bleeding and improve certain outcome parameters without a demonstrated increased risk of thromboembolic disease.

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