【摘要】 目的 比较氨甲环酸两种给药方式对老年髋关节置换术患者出血量及安全性的影响。方法 选取2018年1月～2022年12月期间在深圳市第二人民医院行髋关节置换术的老年患者283例，所有患者常规术前静脉滴注氨甲环酸15 mg/kg，其中135例术中关闭切口前局部浸润2 g氨甲环酸（局部浸润组），148例术中关闭切口前关节腔注射2 g氨甲环酸（局部注射组）。比较两组患者围手术期失血情况[术后24 h出血量、血红蛋白（Hb）下降值]，比较两组患者凝血指标变化，对比两组术后短期并发症发生率。结果 局部浸润组术后24 h失血量（0.541±0.320）L，局部注射组为（0.563±0.342）L，差异无统计学意义（P > 0.05）。局部浸润组术后24 h血红蛋白下降（17.57±10.327）g/L，术后3d下降（23.20±11.004）g/L；局部注射组术后24 h血红蛋白下降（17.67±9.968）g/L，术后3 d下降（21.05±15.036）g/L，两组差异无统计学意义（P > 0.05）。局部注射组术后24 h凝血酶原时间（PT）变化、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）延长时间均少于局部浸润组，差异有统计学意义（P<0.05）；两组患者术后24 h血浆纤维蛋白原（FBG）、D-二聚体改变差异无统计学意义（P > 0.05）。局部浸润组术后并发症发生率56.30%(76/135)，局部注射组为22.97%(34/148)，差异有统计学意义（P<0.05）。结论 老年髋关节置换术中局部注射氨甲环酸较局部浸润氨甲环酸对患者凝血指标波动影响较小，且术后短期并发症发生率低于局部浸润给药。更多还原

【Abstract】 Objective To compare the effects of two tranexamic acid administration methods on bleeding volume and safety in elderly patients with hip arthroplasty. Methods A total of 283 elderly patients who underwent hip replacement surgery in Shenzhen Second People’s Hospital from January 2018 to December 2022 were selected. All patients received routine preoperative intravenous infusion of 15 mg/kg tranexamic acid, of which 135 patients received 2 g tranexamic acid before closing the incision during surgery( local infiltration group), and 148 patients received 2 g tranexamic acid injection into the joint cavity before closing the incision during surgery(local injection group). Compare the perioperative blood loss [24-hour postoperative bleeding volume, hemoglobin(Hb) decrease] between two groups of patients, compare the changes in coagulation indicators between the two groups of patients, and compare the incidence of short-term postoperative complications between the two groups. Results In the local infiltration group, the blood loss within 24 hours after surgery was(0.541±0.320)L, while in the local injection group, it was(0.563±0.342)L. The difference was not statistically significant( P > 0.05). In the local infiltration group, hemoglobin decreased by(17.57±10.327)g/L within 24 hours after surgery and by(23.20±11.004)g/L after 3 days. In the local injection group, hemoglobin decreased by(17.67±9.968)g/L within 24 hours after surgery and by(21.05±15.036)g/L after 3 days. The differences in hemoglobin reduction between the two groups were not statistically significant( P > 0.05). In the local injection group, the changes in prothrombin time(PT), international normalized ratio(INR), activated partial thromboplastin time(APTT), and thrombin time(TT) within 24 hours after surgery were all smaller than those in the local infiltration group, with statistically significant differences(P < 0.05). However, the differences in plasma fibrinogen(FBG) and D-dimer changes between the two groups within 24 hours after surgery were not statistically significant(P > 0.05). The postoperative complication rate was 56.30%(76/135) in the local infiltration group and 22.97%(34/148) in the local injection group, and the difference was statistically significant( P < 0.05). Conclusion Local injection of tranexamic acid during elderly hip replacement surgery has a smaller impact on coagulation indicators compared to local infiltration of tranexamic acid, and the incidence of short-term postoperative complications is lower than that of local infiltration administration.更多还原