Camarasa Godoy M A, Serra-Prat M, Palomera Fanegas E
Servicio de Anestesiología, Reanimación y Clínica del Dolor, Hospital de Mataró, Barcelona.
Rev Esp Anestesiol Reanim. 2008 Feb;55(2):75-80. doi: 10.1016/s0034-9356(08)70513-9.
To evaluate the effectiveness of treatment with tranexamic acid, compared to absence of antifibrinolytic treatment, in reducing transfusion rates and the number of units of packed red blood cells required in patients undergoing total knee replacement surgery.
We reviewed the medical records of all patients who underwent total knee replacement surgery in a general hospital in 2006. Information was recorded on treatment with tranexamic acid, use of other antifibrinolytic drugs, hemoglobin and hematocrit levels before surgery and 3 days after surgery, patients requiring transfusions, units of packed red blood cells administered, and whether or not drains were clamped within 4 hours. Complications attributable to tranexamic acid (thromboembolic or systemic complications) and preoperative treatment with erythropoietin were also recorded.
Data for 166 patients were analyzed. Of these, 120 (72.3%) received tranexamic acid, 15 (9%) received epsilon-aminocaproic acid, and 31 (18.7%) received no antifibrinolytic treatment. Transfusions were given to 17 patients, of whom 6 (5.0%) had received tranexamic acid, 2 (133%) had received epsilon-aminocaproic acid, and 9 (29.0%) had received no antifibrinolytic treatment. The mean numbers of packed red blood cell units transfused in each group were as follows: 0.075 in the tranexamic acid group, 0.200 in the epsilon-aminocaproic acid group, and 0.645 in the group with no antifibrinolytic treatment (P < .001). The mean decrease in hemoglobin levels 5 days after surgery was 3.04 g/dL in the tranexamic acid group, 3.55 g/dL in the epsilon-aminocaproic acid group and 3.76 g/dL in the group with no antifibrinolytic treatment (P < .001).
Tranexamic acid is effective in reducing the percentage of patients requiring transfusions and in the number of units of packed red blood cells required in total knee replacement surgery. No complications attributable to this treatment were found.
与未进行抗纤溶治疗相比，评估氨甲环酸治疗在降低全膝关节置换手术患者输血率及所需浓缩红细胞单位数量方面的有效性。
我们回顾了2006年在一家综合医院接受全膝关节置换手术的所有患者的病历。记录了有关氨甲环酸治疗、其他抗纤溶药物的使用、手术前及手术后3天的血红蛋白和血细胞比容水平、需要输血的患者、输注的浓缩红细胞单位数量以及术后4小时内引流管是否夹闭的信息。还记录了与氨甲环酸相关的并发症（血栓栓塞或全身并发症）以及术前促红细胞生成素治疗情况。
分析了166例患者的数据。其中，120例（72.3%）接受了氨甲环酸治疗，15例（9%）接受了6-氨基己酸治疗，31例（18.7%）未接受抗纤溶治疗。17例患者接受了输血，其中6例（5.0%）接受了氨甲环酸治疗，2例（13.3%）接受了6-氨基己酸治疗，9例（29.0%）未接受抗纤溶治疗。每组输注的浓缩红细胞单位平均数量如下：氨甲环酸组为0.075，6-氨基己酸组为0.200，未接受抗纤溶治疗组为0.645（P < .001）。术后5天血红蛋白水平的平均下降幅度在氨甲环酸组为3.04 g/dL，6-氨基己酸组为3.55 g/dL，未接受抗纤溶治疗组为3.76 g/dL（P < .001）。
氨甲环酸在降低全膝关节置换手术中需要输血的患者百分比及所需浓缩红细胞单位数量方面有效。未发现该治疗引起的并发症。
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