Deng Zengfa, Sheng Puyi, Xu Dongliang, Fu Ming, He Aishan, Liao Weiming, Kang Yan
Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Jul 15;34(7):889-894. doi: 10.7507/1002-1892.201911083.
To explore the effect of tranexamic acid (TXA) on the transfusion rate, dominant blood loss, and postoperative complications in simultaneous bilateral total hip arthroplasty (SBTHA).
A clinical data of 72 patients who underwent the primary SBTHA between January 2010 and December 2018 was retrospectively analyzed. A single dose of 15 mg/kg TXA was administered intravenously before 5-10 minutes of operation in 48 patients of trial group and 24 patients were not treated with TXA in the control group. There was no significant difference between the two groups ( >0.05) in the gender, age, body mass index, the type of disease, American Society of Anesthesiologists (ASA) grading, comorbidity, and preoperative hospital stay, hemoglobin, hematocrit, platelet count, coagulation function tests. The operation time, intraoperative blood loss, and postoperative transfusion rate, dominant blood loss, complication, and hospital stay were recorded and compared between the two groups.
The median operation time of the trial group was 208.0 minutes, and that of the control group was 202.5 minutes, with no significant difference ( =-1.046, =0.295). Postoperative transfusion was performed in 26 patients (54.2%) in the trial group and 21 patients (87.5%) in the control group, and the difference of transfusion rate between the two groups was significant ( =7.843, =0.005). However, there was no significant difference in the amount of transfused suspended red blood cells and plasma between the two groups ( >0.05). The median intraoperative blood loss was 550 mL in the trial group and 600 mL in the control group, with no significant difference ( =-1.378, =0.168). The postoperative drainage volume and median dominant blood loss in the trial group were (542±269) and 1 050 mL, respectively, which were significantly lower than those in the control group [(710±316) and 1 270 mL] ( <0.05). There was 1 case of skin tension blisters around the incision, 1 case of lower limb numbness and muscle strength loss, and 1 case of lacunar cerebral infarction in the trial group, while in the control group, there was 1 case of skin ecchymosis around the incision and 1 case of bilateral lower limb numbness and muscle strength loss, which showed no significant difference in the incidences of complications ( >0.05). No pulmonary embolism or deep venous thrombosis was found in the two groups. The median postoperative hospital stay and median total hospital stay were 9.0 and 13.0 days in the trial group, while 9.0 and 13.0 days in the control group, respectively, with no significant difference ( >0.05).
For patients who are treated with the primary SBTHA, TXA can reduce transfusion rate and perioperative dominant blood loss, and has a good hemostatic effect without increasing complications of incision, pulmonary embolism, deep venous thrombosis, and hospital stay. Therefore, TXA is relative safe.
探讨氨甲环酸（TXA）对同期双侧全髋关节置换术（SBTHA）输血率、主要失血量及术后并发症的影响。
回顾性分析2010年1月至2018年12月期间接受初次SBTHA的72例患者的临床资料。试验组48例患者在手术前5 - 10分钟静脉注射单剂量15 mg/kg TXA，对照组24例患者未接受TXA治疗。两组在性别、年龄、体重指数、疾病类型、美国麻醉医师协会（ASA）分级、合并症及术前住院时间、血红蛋白、血细胞比容、血小板计数、凝血功能检查等方面无显著差异（>0.05）。记录并比较两组的手术时间、术中失血量、术后输血率、主要失血量、并发症及住院时间。
试验组中位手术时间为208.0分钟，对照组为202.5分钟，差异无统计学意义（=-1.046，=0.295）。试验组26例患者（54.2%）术后输血，对照组21例患者（87.5%）术后输血，两组输血率差异有统计学意义（=7.843，=0.005）。然而，两组输注悬浮红细胞和血浆的量差异无统计学意义（>0.05）。试验组中位术中失血量为550 mL，对照组为600 mL，差异无统计学意义（=-1.378，=0.168）。试验组术后引流量和中位主要失血量分别为（542±269）和1050 mL，显著低于对照组[（710±316）和1270 mL]（<0.05）。试验组有1例切口周围皮肤张力性水疱、1例下肢麻木及肌力减退、1例腔隙性脑梗死，对照组有1例切口周围皮肤瘀斑、1例双侧下肢麻木及肌力减退，两组并发症发生率差异无统计学意义（>0.05）。两组均未发现肺栓塞或深静脉血栓形成。试验组术后中位住院时间和总中位住院时间分别为9.0天和13.0天，对照组分别为9.0天和13.0天，差异无统计学意义（>0.05）。
对于接受初次SBTHA治疗的患者，TXA可降低输血率和围手术期主要失血量，具有良好的止血效果，且不增加切口、肺栓塞、深静脉血栓形成及住院时间等并发症。因此，TXA相对安全。
