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氨甲环酸在同期双侧全膝关节置换术中的应用:静脉内和关节内应用哪种更有效?

Tranexamic acid use in simultaneous bilateral total knee arthroplasty : a comparison of intravenous and intra-articular applications, which is more effective?

出版信息

Acta Orthop Belg. 2021 Sep;87(3):479-486.

Abstract

Patients applied with simultaneous bilateral total knee arthroplasty (SBTKA) with the administration of intravenous or intra-articular tranexamic acid (TXA) were compared in respect of blood loss and the need for allogenic blood transfusion. Of a total 53 patients applied with SBTKA, 32(60%) were administered intravenous TXA and 21(40%) intra-articular TXA. The patients were evaluated in respect of age, gender, height, weight, body mass index (BMI), body blood volume, preoperative and 1,2,3 and 4 days postoperative levels of hemoglobin (Hb) and hematocrit (Htc) and the change in Hb levels, estimated blood loss, mean actual blood loss, the need for allogenic blood transfusion (ABT) and the use or not of a drain. No difference was determined between the intravenous and intra-articular groups in respect of mean age, gender, height, weight, and body blood volume. No difference was determined between the groups in preoperative and postoperative mean Hb and Hct values, the reduction in mean Hb postoperatively, estimated blood loss, or the need for ABT. No deep vein thrombosis or pulmonary embolism was determined in any patient. In the application of SBTKA, TXA can be safely administered by the intravenous or intra-articular route to reduce the need for ABT. The results of this study determined no difference in efficacy between the routes of application. For patients with a risk of intravenous use, intra-articular application can be preferred.

摘要

比较了接受静脉或关节内氨甲环酸(TXA)给药的同期双侧全膝关节置换术(SBTKA)患者的失血量和异体输血需求。在接受 SBTKA 的 53 名患者中,32 名(60%)接受静脉 TXA 治疗,21 名(40%)接受关节内 TXA 治疗。评估了患者的年龄、性别、身高、体重、体重指数(BMI)、体血容量、术前和术后 1、2、3、4 天的血红蛋白(Hb)和血细胞比容(Htc)水平以及 Hb 水平的变化、估计失血量、实际平均失血量、异体输血(ABT)需求以及引流管的使用情况。静脉组和关节内组在平均年龄、性别、身高、体重和体血容量方面无差异。两组在术前和术后平均 Hb 和 Hct 值、术后平均 Hb 下降、估计失血量或 ABT 需求方面无差异。未在任何患者中发现深静脉血栓形成或肺栓塞。在 SBTKA 的应用中,静脉或关节内给予 TXA 可安全减少 ABT 的需求。本研究结果确定两种给药途径的疗效无差异。对于有静脉使用风险的患者,可优先选择关节内应用。

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