Gillespie Robert, Shishani Yousef, Joseph Sheeba, Streit Jonathan J, Gobezie Reuben
Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
The Cleveland Shoulder Institute, University Hospitals of Cleveland, Beachwood, OH, USA.
J Shoulder Elbow Surg. 2015 Nov;24(11):1679-84. doi: 10.1016/j.jse.2015.07.029.
Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to significantly reduce blood loss and transfusion requirements after total knee and hip arthroplasty. The purpose of this study was to evaluate the effect of TXA on postoperative blood loss after shoulder arthroplasty.
A total of 111 patients (62 women; average age, 67 years) who underwent shoulder arthroplasty were prospectively randomized in double-blinded fashion to receive either 100 mL of normal saline or 100 mL of normal saline with 2 g TXA by topical application into the wound at the completion of the case. All patients received a postoperative drain. Drain output representing postoperative blood loss, transfusion requirements, and change in hemoglobin level were recorded. All postoperative complications were noted.
The average blood loss recorded after surgery was 170 mL in the placebo group and 108 mL in the TXA group (P = .017). The average change in hemoglobin level was 2.6 g/dL in the placebo group and 1.7 g/dL in the TXA group (P < .001). There were no transfusion requirements or postoperative complications noted in either group.
In this cohort of patients, those treated with TXA experienced a significantly lower amount of postoperative blood loss and a significantly smaller change in hemoglobin level compared with those treated with placebo. Further work is required to determine the effectiveness and clinical significance of TXA in reducing transfusion requirements in shoulder arthroplasty and, more specifically, shoulder arthroplasty performed for complicated patients or for trauma and fracture patients.
氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，已被证明可显著减少全膝关节和髋关节置换术后的失血量及输血需求。本研究的目的是评估TXA对肩关节置换术后失血量的影响。
总共111例接受肩关节置换术的患者（62例女性；平均年龄67岁）被前瞻性地随机分为双盲组，一组在手术结束时经伤口局部应用100 mL生理盐水，另一组经伤口局部应用含2 g TXA的100 mL生理盐水。所有患者术后均放置引流管。记录代表术后失血量、输血需求及血红蛋白水平变化的引流量。记录所有术后并发症。
安慰剂组术后平均失血量为170 mL，TXA组为108 mL（P = 0.017）。安慰剂组血红蛋白水平平均变化为2.6 g/dL，TXA组为1.7 g/dL（P < 0.001）。两组均未出现输血需求或术后并发症。
在这组患者中，与接受安慰剂治疗的患者相比，接受TXA治疗的患者术后失血量显著更低，血红蛋白水平变化也显著更小。需要进一步开展研究以确定TXA在减少肩关节置换术输血需求方面的有效性和临床意义，更具体地说，是对复杂患者或创伤及骨折患者进行肩关节置换术时的有效性和临床意义。
