Singh Jagwant, Ballal Moez S, Mitchell P, Denn P G
Macclesfield District General Hospital, Cheshire, United Kingdom.
J Orthop Surg (Hong Kong). 2010 Dec;18(3):282-6. doi: 10.1177/230949901001800305.
To assess the effects of tranexamic acid (TA) in patients undergoing total hip arthroplasty (THA) for osteoarthritis.
42 patients underwent primary THA for osteoarthritis by a single surgeon. 10 men and 11 women who did not receive TA were controls, whereas 9 men and 12 women who received TA constituted the treatment group. Both groups were matched for age, gender, body mass index, and American Society of Anesthesiologists grading. The type of prosthesis used (cemented or uncemented) was based on the surgeon's preference and patient age, activity level and demands. No hybrid prosthesis was used. 10 minutes prior to incision, a single dose of intravenous TA (10 mg per kg body weight) was given to patients in the treatment group. Comparison was made between both groups with regard to intra-operative blood loss, postoperative reduction in haemoglobin and haematocrit levels, blood transfusion, incidence of deep vein thrombosis, and the length of hospital stay.
The mean intra-operative blood loss (489 [SD, 281] vs. 339 [SD, 184] ml, p = 0.048) and the decrease in haemoglobin level (38 [SD, 12] vs. 29 [SD, 10] g/l, p=0.014) were significantly higher in the control than the treatment group. Two patients among the controls received a transfusion, compared to none in the TA group (p = 0.49, Fisher's exact test). The 2 patients who needed blood transfusion had blood losses of 600 and 690 ml, compared to a mean of 489 ml in the whole group. No patient in either group developed deep vein thrombosis or pulmonary embolism up to 3 months.
A single dose of intravenous TA (10 mg per kg body weight) given 10 minutes prior to THA is a cost-effective and safe means of minimising blood loss and reduction in haemoglobin concentrations as well as the need for allogenic blood transfusion, without increasing the risk of thromboembolic events.
评估氨甲环酸（TA）对因骨关节炎接受全髋关节置换术（THA）患者的影响。
42例因骨关节炎接受初次THA的患者由同一位外科医生实施手术。10名男性和11名女性未接受TA作为对照组，而9名男性和12名女性接受TA构成治疗组。两组在年龄、性别、体重指数和美国麻醉医师协会分级方面进行匹配。所使用假体的类型（骨水泥型或非骨水泥型）基于外科医生的偏好以及患者的年龄、活动水平和需求。未使用混合型假体。在切开前10分钟，给治疗组患者静脉注射单剂量TA（每千克体重10毫克）。比较两组在术中失血量、术后血红蛋白和血细胞比容水平的降低、输血情况、深静脉血栓形成的发生率以及住院时间。
对照组的平均术中失血量（489[标准差，281]对339[标准差，184]毫升，p = 0.048）和血红蛋白水平的下降（38[标准差，12]对29[标准差，10]克/升，p = 0.014）显著高于治疗组。对照组中有2例患者接受了输血，而TA组无输血患者（p = 0.49，Fisher精确检验）。这2例需要输血的患者失血量分别为600和690毫升，而整个对照组的平均失血量为489毫升。两组中均无患者在3个月内发生深静脉血栓形成或肺栓塞。
在THA前10分钟静脉注射单剂量TA（每千克体重10毫克）是一种经济有效的安全方法，可减少失血量、降低血红蛋白浓度以及同种异体输血的需求，且不增加血栓栓塞事件的风险。
