Mannová J, Kubát P, Pospíchal M, Longin P
Anesteziologicko-resuscitační oddělení, Nemocnice Havlíčkův Brod.
Acta Chir Orthop Traumatol Cech. 2019;86(2):118-123.
PURPOSE OF THE STUDY To evaluate the efficacy of the systemic administration of two doses of tranexamic acid (TXA) in total knee (TKA) and hip arthroplasty (THA). MATERIAL AND METHODS The study evaluated a total of 295 patients who underwent total knee and hip arthroplasty for osteoarthritis, prospectively followed up were the patients who had been administered the tranexamic acid (TXA), and this group was subsequently compared against the cohort - control group. Our evaluation was focused on perioperative and postoperative period. The amount of blood loss was monitored during the surgery as well as postoperatively. Moreover, the frequency and the volume of administered allogeneic blood transfusions and in TKA also autotransfusion requirement were observed. The patients postoperative hemoglobin levels were compared in both the groups when the patients were in the ICU and the frequency of all postoperative complications was monitored. The statistical analysis was carried out separately for hip and knee replacement. RESULTS Our study confirmed that the systemic application of tranexamic acid in two 10-15 mg/kg doses in knee arthroplasty resulted in a statistically significant reduction of perioperative and postoperative blood loss, lower frequency of administration of allogeneic blood transfusion, but also in lower frequency in the administration of any transfusion, including autotransfusion. In patients who underwent total hip arthroplasty, the administration of TXA led to a statistically significant reduction of postoperative bleeding. The patients with total knee as well as hip arthroplasty, who had been administered TXA, showed significantly higher haemoglobin levels when transferred from the ICU. No significant difference was found in deep vein thrombosis, pulmonary embolism or other postoperative complications among the study groups. DISCUSSION There is no homogeneity in the already published studies proving the efficacy of TXA in TKA and THA, they differ considerably as to the method of administration of the tranexamic acid. The differences concern the systemic and local application, dosage and time of administration. In some studies, TXA was administered in a single dose only, whereas in other studies it was administered repeatedly, in the form of a bolus or continuously. In our study we confirmed the efficacy of systemic administration of tranexamic acid in two repeated bolus doses of 10-15 mg/kg, namely before the commencement of the surgery and at the end of the surgery. CONCLUSIONS The administration of tranexamic acid in two IV doses of 10-15 mg/kg to patients with total knee and hip arthroplasty has proven to be efficient. A higher efficacy of TXA was reported in TKA and due to routine administration of TXA the postoperative autotransfusion system (ORTHO P.A.S.) ceased to be used in knee replacement surgery. Key words:total hip arthroplasty, total knee arthroplasty, tranexamic acid, blood loss, allogeneic transfusion, autotransfusion, postoperative complications.
研究目的 评估两剂氨甲环酸（TXA）全身给药在全膝关节置换术（TKA）和全髋关节置换术（THA）中的疗效。
材料与方法 该研究共评估了295例行全膝关节和全髋关节置换术治疗骨关节炎的患者，对接受氨甲环酸（TXA）治疗的患者进行前瞻性随访，并将该组患者与队列对照组进行比较。我们的评估集中在围手术期和术后阶段。在手术期间以及术后监测失血量。此外，观察异体输血的频率和量，在全膝关节置换术中还观察自体输血需求。比较两组患者在重症监护病房（ICU）时的术后血红蛋白水平，并监测所有术后并发症的发生频率。对髋关节和膝关节置换分别进行统计分析。
结果 我们的研究证实，在膝关节置换术中全身应用两剂10 - 15mg/kg的氨甲环酸可使围手术期和术后失血量在统计学上显著减少，异体输血给药频率降低，包括自体输血在内的任何输血给药频率也降低。在接受全髋关节置换术的患者中，氨甲环酸的应用使术后出血在统计学上显著减少。接受氨甲环酸治疗的全膝关节和全髋关节置换患者从ICU转出时血红蛋白水平显著更高。研究组之间在深静脉血栓形成、肺栓塞或其他术后并发症方面未发现显著差异。
讨论 已发表的证明氨甲环酸在全膝关节置换术和全髋关节置换术中疗效的研究并不统一，在氨甲环酸的给药方法上差异很大。这些差异涉及全身和局部应用、剂量和给药时间。在一些研究中，氨甲环酸仅单次给药，而在其他研究中则以推注或持续给药的形式重复给药。在我们的研究中，我们证实了以10 - 15mg/kg的剂量分两次重复推注全身应用氨甲环酸的疗效，即在手术开始前和手术结束时给药。
结论 对全膝关节和全髋关节置换患者静脉注射两剂10 - 15mg/kg的氨甲环酸已被证明是有效的。在全膝关节置换术中氨甲环酸的疗效更高，并由于常规应用氨甲环酸，全膝关节置换手术不再使用术后自体输血系统（ORTHO P.A.S.）。
全髋关节置换术；全膝关节置换术；氨甲环酸；失血；异体输血；自体输血；术后并发症
