Zhang Fujiang, Gao Zhiguo, Yu Jianhua
Department of Joint Surgery, Tianjin Hospital, Tianjin Medical University, Tianjin, 300211, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Dec;21(12):1302-4.
To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty (TKA).
From June 2005 to June 2006, 102 patients (43 males, 59 females; aged 59-77 years, averaged 68 years) underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis. The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.
The blood loss was 256 +/- 149 ml in Group A and 306 +/- 214 ml in Group B during operation; there was no significant difference between the two groups (P > 0.05). The postoperative drainage volume was 478 +/- 172 ml in Group A and 814 +/- 156 ml in Group B, and the total blood loss was 559 +/- 159 ml in Group A and 1208 +/- 243 ml in Group B; there were significant differences between the two groups (P < 0.05). The averaged amount of blood transfusion was 556 +/- 174 ml in Group A and 1024 +/- 278 ml in Group B; there was a significant difference between the two groups (P < 0. 05). The postoperative hemoglobin concentration was higher in Group A than that in Group B (1.0-1.1 g/dL vs. 0.6-0.8 g/dL). The postoperative follow-up for 6-12 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation (0.92 +/- 0.56 mg/L vs. 0.35 +/- 0.13 mg/L in Group A; 1.32 +/- 0.79 mg/L vs. 0.37 +/- 0.21 mg/L in Group B) (P < 0.05). The D-dimeride level 3 hours after operation was significantly higher in Group B than in Group A (P < 0.05). There were no significant differences in the levels of fibrinogen, prothrombin time,.and activated partial thromboplastin time between the two groups (P > 0.05).
During and after the TKA operation, a short-term use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
探讨氨甲环酸对全膝关节置换术（TKA）相关失血的影响。
2005年6月至2006年6月，102例患者（男43例，女59例；年龄59 - 77岁，平均68岁）接受了TKA手术。102例患者中，59例患有骨关节炎，23例患有类风湿关节炎，20例患有创伤性关节炎。病程为2至12年。他们被随机分为A组和B组，每组51例。A组患者接受氨甲环酸治疗，B组患者接受等量的生理盐水。在A组中，1 g氨甲环酸溶解于250 ml生理盐水中，在松开止血带前静脉输注；3小时后再静脉给予相同剂量的同一药物。在B组中，仅静脉输注250 ml生理盐水。记录102例患者手术中和手术后的失血量和输血量。观察他们是否发生深静脉血栓形成。还在手术前、手术中（松开止血带时）和手术后3小时检测D - 二聚体、纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间。
手术中A组失血量为256±149 ml，B组为306±214 ml；两组间差异无统计学意义（P>0.05）。A组术后引流量为478±172 ml，B组为814±156 ml，A组总失血量为559±159 ml，B组为1208±243 ml；两组间差异有统计学意义（P<0.05）。A组平均输血量为556±174 ml，B组为1024±278 ml；两组间差异有统计学意义（P<0.05）。A组术后血红蛋白浓度高于B组（1.0 - 1.1 g/dL对0.6 - 0.8 g/dL）。术后6至12个月随访显示，彩色多普勒超声检查发现患者双下肢均未发生深静脉血栓形成。术后3小时D - 二聚体水平显著高于术前（A组：0.92±0.56 mg/L对0.3
