Rajesparan K, Biant L C, Ahmad M, Field R E
The Elective Orthopaedic Centre, Epsom, Surrey, UK.
J Bone Joint Surg Br. 2009 Jun;91(6):776-83. doi: 10.1302/0301-620X.91B6.22393.
Tranexamic acid is a fibrinolytic inhibitor which reduces blood loss in total knee replacement. We examined the effect on blood loss of a standardised intravenous bolus dose of 1 g of tranexamic acid, given at the induction of anaesthesia in patients undergoing total hip replacement and tested the potential prothrombotic effect by undertaking routine venography. In all, 36 patients received 1 g of tranexamic acid, and 37 no tranexamic acid. Blood loss was measured directly per-operatively and indirectly post-operatively. Tranexamic acid reduced the early post-operative blood loss and total blood loss (p = 0.03 and p = 0.008, respectively) but not the intraoperative blood loss. The tranexamic acid group required fewer transfusions (p = 0.03) and had no increased incidence of deep-vein thrombosis. The reduction in early post-operative blood loss was more marked in women (p = 0.05), in whom this effect was dose-related (r = -0.793). Our study showed that the administration of a standardised pre-operative bolus of 1 g of tranexamic acid was cost-effective in reducing the blood loss and transfusion requirements after total hip replacement, especially in women.
氨甲环酸是一种纤维蛋白溶解抑制剂，可减少全膝关节置换术中的失血。我们研究了在全髋关节置换术患者麻醉诱导时给予1克氨甲环酸的标准化静脉推注剂量对失血的影响，并通过常规静脉造影检查其潜在的促血栓形成作用。共有36例患者接受了1克氨甲环酸，37例未接受氨甲环酸。术中直接测量失血量，术后间接测量失血量。氨甲环酸减少了术后早期失血量和总失血量（分别为p = 0.03和p = 0.008），但未减少术中失血量。氨甲环酸组需要的输血次数更少（p = 0.03），深静脉血栓形成的发生率没有增加。术后早期失血量的减少在女性中更为明显（p = 0.05），且这种效应与剂量相关（r = -0.793）。我们的研究表明，术前给予1克氨甲环酸的标准化推注在减少全髋关节置换术后的失血量和输血需求方面具有成本效益，尤其是在女性中。
