【摘要】 目的探讨氨甲环酸不同给药方式对类风湿性关节炎(RA)患者行全膝关节置换术(TKA)围术期失血量的影响。方法收集自2012-03—2015-04在本院初次行TKA治疗的106例RA患者,随机分为静脉给药组、关节注射组和联合组,静脉给药组于止血带充气前15 min静滴氨甲环酸(TXA)1g,关节注射组术毕缝合关节囊后经关节囊切口注射TXA 1g,联合组于止血带充气前15 min静滴TXA 1g,术毕缝合关节囊后经关节囊切口注射TXA 1g。结果联合组术后24、72 h Hb、Hct均高于静脉给药组和关节注射组,引流量、隐性失血量和总失血量均低于静脉给药组和关节注射组,差异有统计学意义(P<0.05);3组术前和术后Fib、PT和APTT比较差异无统计学意义(P>0.05);静脉给药组和联合组均无输血者,3组均未发现DVT和肺栓塞。结论 RA患者TKA术前静脉滴注TXA联合经关节囊局部用药可减少围术期失血量,且不会增加DVT和肺栓塞发生风险。更多还原

【Abstract】 Objective To investigate the effects of different modes of administration of tranexamic acid on perioperative blood loss in RA patients undergoing total knee replacement surgery. Methods One hundred and sixteen patients with RA receiving primary TKA in our hospital from March 2012 to April 2015 were collected. They were randomly divided into intravenous administration group, intraarticular injection group and combined group. Patients in intravenous administration group were infused intravenously TXA 1g at 15 min before tourniquet was inflated. Patients in intraarticular injection group were injected TXA 1g after capsules were sutured. Patients in combined group were infused intravenously TXA 1g at 15 min before tourniquet was inflated and injected TXA 1g after capsules were sutured. Results The Hb and Hct 24 h and 72 h after surgery in the combined group were higher than those in the intravenous administration group and intraarticular injection group, while the drainage volumes, total amount of blood loss and invisible blood loss were lower than the intravenous administration group and intraarticular injection group(P <0.05). The differences of Fib, PT and APTT before and after surgery in the three groups were not significant(P >0.05). There were no blood transfusion in the intravenous administration group and combined group. There were no DVT and pulmonary embolism in the three groups. Conclusion Preoperative intravenous infusion of TXA combined with topical medication in articular capsule could further reduce the perioperative blood loss of RA patients, and do not increase the risk of DVT and pulmonary embolism.更多还原