全髋关节置换术中氨甲环酸不同给药途径对手术效果的影响及安全性分析

doi:10.3969/j.issn.1005-6483.2021.04.005

摘要/Abstract

摘要： 目的：探讨氨甲环酸在全髋关节置换术中不同给药途径对手术效果及安全性的影响。方法：2017年2月~2020年7月期间在院实施全髋关节置换术的病人79例，其中41例术中采用氨甲环酸关节腔局部粉剂给药(A组)，38例术中采用氨甲环酸静脉滴注给药(B组)。比较两组病人围手术期失血情况[术中出血量、术后引流量、总出血量、血红蛋白(Hb)及红细胞比容(Hct)下降值]，比较两组病人纤溶指标、炎症指标变化，对比两组并发症发生率。结果：A组术中出血量与B组比较，差异无统计学意义(P＞0.05)，A组术后引流量、总出血量、Hb与Hct下降值均少于B组(P＜0.05)。两组术后血浆纤维蛋白原(Fg)、纤维蛋白原降解产物(FDP)、D二聚体(DD)水平均较术前升高(P＜0.05)，两组间术前及术后血浆Fg、FDP、DD比较，差异无统计学意义(P>0.05)。两组术后血清C反应蛋白(CRP)、肿瘤坏死因子（TNF）α水平均较术前升高(P＜0.05)；两组术前及术后血清CRP、TNFα水平比较，差异无统计学意义(P>0.05)。两组间下肢深静脉血栓形成、切口感染发生率及并发症总发生率比较，差异无统计学意义(P>0.05)。结论：全髋关节置换术中应用局部粉剂给药较静脉给药能减少隐性失血，两种给药方式对炎症因子水平的影响及安全性相当。

关键词: 全髋关节置换术, 氨甲环酸, C反应蛋白, 肿瘤坏死因子α

Abstract: Objective：To investigate the effect of different administration routes of tranexamic acid on inflammatory factors and safety during total hip arthroplasty.Methods：The clinical data of 79 patients undergoing total hip arthroplasty in our hospital from February 2017 to July 2020 were retrospectively analyzed.Among them,41 cases were treated with tranexamic acid intra articular cavity local powder(group A),and 38 cases were treated with tranexamic acid intravenous drip(group B).The perioperative blood loss [intraoperative blood loss,postoperative drainage volume,total blood loss,hemoglobin(HB) and hematocrit(Hct) decreased value ] of the two groups were compared.The changes of fibrinolytic index and inflammatory index were compared between the two groups.The incidence of complications was compared between the two groups.Results：There was no significant difference in the amount of intraoperative blood loss between group A and group B(P>0.05).The postoperative drainage volume,total blood loss,Hb and HCT decreased value in group A were less than those in group B(P<0.05).Plasma fibrinogen(Fg),fibrinogen degradation product(FDP),and Ddimer(DD) levels after surgery in the two groups were higher than those before surgery(P＜0.05).There was no statistically significant difference in plasma Fg,FDP,DD before and after operation between the two groups(P>0.05).The levels of serum Creactive protein(CRP) and tumor necrosis factorα(TNFα) in the two groups were higher than those before operation(P＜0.05).There was no significant difference in serum CRP and TNFα levels before and after operation between the two groups(P>0.05).There was no significant difference in the incidence of deep vein thrombosis,incision infection and total incidence of complications between the two groups(P>0.05).Conclusion：The application of topical powder during total hip replacement surgery can reduce hidden blood loss compared with intravenous administration.The two methods of administration have the same effect on the level of inflammatory factors and their safety.

Key words: total hip replacement, tranexamic acid, Creactive protein, tumor necrosis factorα

蒋仁义, 潘宏, 郑毅. 全髋关节置换术中氨甲环酸不同给药途径对手术效果的影响及安全性分析[J]. 临床外科杂志, 2021, 29(4): 318-321.

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