Sandri Andrea, Mimor Bogdan Florentin, Ditta Alessandro, Finocchio Eliana, Danzi Vinicio, Piccoli Pierluigi, Regis Dario, Magnan Bruno
Department of Orthopaedic and Trauma Surgery, University of Verona - Italy.
Acta Biomed. 2019 Jan 10;90(1-S):81-86. doi: 10.23750/abm.v90i1-S.8085.
Blood loss and transfusion requirements are common in total hip arthroplasty. Tranexamic acid is one of the most interesting options to reduce the need for blood transfusions in a variety of surgical settings. The aim of this study was to assess the efficacy of perioperative intravenous traxexamic acid regarding blood transfusion rate and volume of transfused blood without increasing adverse events after primary elective cementless total hip arthroplasty.
A comparative retrospective study was conducted in 86 healthy patients who had undergone primary cementless total hip artrhoplasty for severe joint diseases at a single institution. All surgical procedures were performed through an anterolateral Watson- Jones approach with the patient in supine position. Forty patients (TXA group) received tranexamic acid 1g as an intravenous bolus 10 minutes before skin incision and a further 1 g, diluted in 250 mL of saline solution, in continuous perfusion at 30 mL/h, following commencement of the surgery. Forty-six patients (control group) did not receive TXA. Outcome measures included BT rate, volume of transfused blood, deep vein thrombosis and occurrence of pulmonary embolism.
BT rate was significantly less for the TXA group (37.5%) compared with the control group (65%; p=0.011). The mean blood volume transfused was also significantly less for the TXA group (240 mL) compared with the control group (450mL; p=0.009). No adverse events occurred in any group. Conclusons: Perioperative intravenous tranexamic acid is effective in reducing blood transfusion rate and volume of transfused blood, without increasing the risk of thromboembolic events in patients undergoing primary cementless total hip arthroplasty.
全髋关节置换术中失血和输血需求很常见。氨甲环酸是在多种手术场景下减少输血需求的最具吸引力的选择之一。本研究的目的是评估在初次择期非骨水泥型全髋关节置换术后，围手术期静脉注射氨甲环酸在不增加不良事件的情况下对输血率和输血量的疗效。
对86例在单一机构因严重关节疾病接受初次非骨水泥型全髋关节置换术的健康患者进行了一项比较性回顾性研究。所有手术均通过前外侧沃森-琼斯入路进行，患者仰卧位。40例患者（氨甲环酸组）在皮肤切开前10分钟静脉推注1g氨甲环酸，手术开始后，再将1g氨甲环酸稀释于250mL盐溶液中，以30mL/h的速度持续灌注。46例患者（对照组）未接受氨甲环酸。观察指标包括输血率、输血量、深静脉血栓形成和肺栓塞的发生情况。
氨甲环酸组的输血率（37.5%）显著低于对照组（65%；p=0.011）。氨甲环酸组的平均输血量（240mL）也显著低于对照组（450mL；p=0.009）。两组均未发生不良事件。结论：围手术期静脉注射氨甲环酸可有效降低初次非骨水泥型全髋关节置换术患者的输血率和输血量，且不增加血栓栓塞事件的风险。
