Mahmood Aatif, Sawalha Seif, Borbora Aaron, Kumar Gunasekaran, Peter Viju
Royal Liverpool and Broadgree University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
Eur J Orthop Surg Traumatol. 2017 Oct;27(7):923-928. doi: 10.1007/s00590-017-1910-3. Epub 2017 Jan 25.
The effectiveness of intravenous tranexamic acid (TA) in reducing blood loss and transfusion requirements during total hip replacement (THR) is well recognised. The aim of this study was to assess the effectiveness of a fibrin sealant in comparison to intravenous TA and a control group.
We prospectively studied 273 patients with primary hip osteoarthritis who underwent a THR between February 2012 and September 2013. The first 73 patients acted as the control group. The next 100 consecutive patients received fibrin sealant spray, and the last 100 patients received 1 g TA on induction.
The demographic characteristics, surgical time, surgeon grade, anaesthetic type and pre-operative haemoglobin of the three groups were comparable. Both fibrin sealant and intravenous TA were effective in reducing blood loss during THR (15%, p = 0.04 and 22.5%, p = 0.01, respectively), when compared to the control group. However, neither treatment was found to be superior to the other in preventing blood loss p = 0.39. Tranexamic acid was superior to fibrin sealant in decreasing allogeneic transfusion requirements (0 vs. 10%, p = 0.05). There was no significant difference between the groups with regard to proportion of patients with wound leaking problems.
Both fibrin sealant and intravenous tranexamic acid were effective in reducing blood loss. However, tranexamic acid use reduced post-operative transfusion requirements.
静脉注射氨甲环酸（TA）在全髋关节置换术（THR）中减少失血和输血需求的有效性已得到充分认可。本研究的目的是评估纤维蛋白密封剂与静脉注射TA及对照组相比的有效性。
我们前瞻性地研究了2012年2月至2013年9月期间接受THR的273例原发性髋骨关节炎患者。前73例患者作为对照组。接下来连续的100例患者接受纤维蛋白密封剂喷雾，最后100例患者在诱导时接受1g TA。
三组患者的人口统计学特征、手术时间、外科医生级别、麻醉类型和术前血红蛋白水平具有可比性。与对照组相比，纤维蛋白密封剂和静脉注射TA在THR期间均能有效减少失血（分别为15%，p = 0.04；22.5%，p = 0.01）。然而，在预防失血方面，两种治疗方法均未显示出优于对方（p = 0.39）。在减少异体输血需求方面，氨甲环酸优于纤维蛋白密封剂（0%对10%，p = 0.05）。在伤口渗漏问题患者比例方面，各组之间无显著差异。
纤维蛋白密封剂和静脉注射氨甲环酸在减少失血方面均有效。然而，使用氨甲环酸可降低术后输血需求。
