Kundu Ratul, Das Anjan, Basunia Sandip Roy, Bhattacharyya Tapas, Chattopadhyay Surajit, Mukherjee Anindya
Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Bankura, India.
Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India.
J Nat Sci Biol Med. 2015 Jan-Jun;6(1):94-9. doi: 10.4103/0976-9668.149099.
Total knee replacement (TKR) is associated with high-perioperative blood loss, which often requires allogenic blood transfusion. Among the many strategies to decrease the need for allogenic transfusion, tranexamic acid (TA) is used systemically in perioperative setting with promising outcome. Here we evaluated the efficacy of single preoperative bolus dose of TA on reduction in blood loss and red blood cell transfusion in patients undergoing unilateral TKR.
70, American Society of Anesthesiologists I-II patients scheduled for unilateral TKR were included. Patients were randomly allocated into two groups to receive either TA (Group-TA; 20 mg/kg diluted to 25 cc with normal saline) or an equivalent volume of normal saline (Group P). Hemoglobin concentration, packed cell volume, platelet count, fibrinogen level, D-dimer level was measured preoperatively and at 6(th) and 24(th) h postoperative period.
In Group P more blood, colloid and crystalloid solutions were used to replace the blood loss. 27 patients in Group TA did not require transfusion of any blood products compared to 6 patients in Group P (P < 0.0001) and only 3 units of blood was transfused in Group TA where as a total of 32 units of blood was transfused in Group P. Despite the more numerous transfusions, Hb% after 6 h and 24 h in Group P were considerably low in comparison with Group TA (P < 0.0001).
Tranexamic acid while significantly reducing blood loss caused by TKR surgery collaterally reduced the need for postoperative blood transfusion.
全膝关节置换术（TKR）与围手术期大量失血相关，这通常需要异体输血。在众多减少异体输血需求的策略中，氨甲环酸（TA）在围手术期全身使用，效果良好。在此，我们评估了术前单次推注TA对单侧TKR患者减少失血和红细胞输血的疗效。
纳入70例计划进行单侧TKR的美国麻醉医师协会I-II级患者。患者被随机分为两组，分别接受TA（TA组；20mg/kg用生理盐水稀释至25cc）或等量生理盐水（P组）。术前以及术后第6小时和第24小时测量血红蛋白浓度、血细胞比容、血小板计数、纤维蛋白原水平、D-二聚体水平。
P组使用了更多的血液、胶体和晶体溶液来补充失血。TA组有27例患者不需要输注任何血液制品，而P组为6例（P<0.0001），TA组仅输注了3单位血液，而P组总共输注了32单位血液。尽管输血次数更多，但P组术后6小时和24小时的血红蛋白百分比与TA组相比明显较低（P<0.0001）。
氨甲环酸在显著减少TKR手术引起的失血的同时，附带减少了术后输血的需求。
