【摘要】 背景:多数研究是在全髋关节置换开始前将氨甲环酸静脉注射入患者体内,观察其对显性及隐形失血的影响,很少有研究观察氨甲环酸治疗后血液中白细胞介素6及C-反应蛋白的变化情况。目的:探讨氨甲环酸局部应用对全髋关节置换围置换期失血以及白细胞介素6和C-反应蛋白的影响。方法:选择2015年1月至2017年1月在青海红十字医院就诊行初次单侧全髋关节置换的75例患者作为研究对象,随机分为治疗组和对照组,治疗组37例在安置假体后给予氨甲环酸静脉点滴,对照组38例在相同时间给予等量的氯化钠静脉点滴。观察并比较2组患者术中失血量、术后引流量、总失血量、隐性出血量、输血量及输血率;测量2组患者术前及术后不同时刻的血红蛋白及红细胞压积、C-反应蛋白及白细胞介素6的表达水平;记录2组患者发热、下肢静脉血栓形成等并发症发生情况。结果与结论:(1)治疗组术后引流量、总出血量、隐性失血量、术后输血量及术后输血率均小于对照组,差异有显著性意义(P <0.05);(2)治疗组术后3 h、1 d、3 d、7 d的血红蛋白及红细胞压积均高于对照组,差异有显著性意义(P <0.05);(3)术后3 h、1 d及3 d时2组患者C-反应蛋白及白细胞介素6水平均逐渐升高,且对照组升高更多(P <0.05);(4)围置换期2组患者无发热、感染及下肢深静脉血栓形成;(5)提示静脉应用氨甲环酸能够安全有效的减少全髋关节置换后出血,且能够降低白细胞介素6及C-反应蛋白释放水平。更多还原

【Abstract】 BACKGROUND: There are many studies addressing the effect of intravenous injection of tranexamic acid before total hip arthroplasty on the dominant and hidden blood loss. But its effects on the levels of interleukin-6 and C-reactive protein are rarely reported.OBJECTIVE: To investigate the effects of local application of tranexamic acid on the blood loss and levels of interleukin-6 and C-reactive protein in the perioperative period of total hip arthroplasty.METHODS: Seventy-five patients undergoing primary unilateral total hip arthroplasty at Qinghai Red Cross Hospital from January 2015 to January 2017 were enrolled. The patients were randomized into treatment group(n=37, intravenous injection of tranexamic acid after prosthesis placed) and control group(n=38, intravenous injection of the same volume of normal saline). The intraoperative blood loss,postoperative drainage volume, total blood loss, hidden blood loss, blood transfusion volume and transfusion rate were compared between two groups. The hemoglobin, hematocrit, the levels of C-reactive protein and interleukin-6 at baseline and different time points postoperatively were measured. The complications like fever or lower extremity venous thrombosis were recorded.RESULTS AND CONCLUSION:(1) The postoperative drainage volume, total blood loss, hidden blood loss, postoperative blood transfusion volume and blood transfusion rate in the treatment group were significantly lower than those in the control group(P < 0.05).(2) The hemoglobin and hematocrit in the treatment group were significantly higher than those in the control group at 3 hours, 1, 3 and 7 days postoperatively(P < 0.05).(3) At postoperative 3 hours, 1 and 3 days, the levels of C-reactive protein and interleukin-6 were gradually increased in both groups, especially the control group(P < 0.05).(4) No fever, infection, or deep venous thrombosis of the lower extremities was observed in both groups.(5) To conclude, intravenous injection of tranexamic acid can reduce the blood loss after total hip arthroplasty safely and effectively, and also can reduce the levels of C-reactive protein and interleukin-6.更多还原