大剂量氨甲环酸对全膝关节置换患者术后纤溶活性与炎症因子的影响

目的:探讨大剂量氨甲环酸对全膝关节置换患者术后纤溶活性与炎症因子的影响。方法:回顾性分析在我院行初次全膝关节置换术的180例患者,按照给药方式分为对照组、常规组、大剂量组,每组各60例。对照组患者直接给予生理盐水,常规组给予10 mg/kg氨甲环酸,大剂量组给予15 mg/kg氨甲环酸。比较三组术后总失血量、隐形失血量、术前与术后3天三组凝血功能(纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间)、纤溶活性纤维蛋白(原)降解产物(FDP)、D-二聚体]以及炎性因子C-反应蛋白(CRP)、白介素-6(IL-6)]水平变化及术后2周血栓事件的发生情况。结果:大剂量组与常规组的总失血量与隐形失血量均明显低于对照组,大剂量组总失血量与隐形失血量均低于常规组(P0.05);三组患者纤维蛋白原、凝血酶原时间以及活化部分凝血活酶时间相比差异均无统计学意义(P0.05);术后3天,大剂量组和常规组FDP与D-二聚体、CRP、IL-6水平均显著低于对照组,且与常规组相比,大剂量组水平较低(P0.05);术后2周,三组肌间静脉血栓发生率比较均无显著差异(P0.05)。结论:在全膝关节置换术后使用氨甲环酸可进一步减少术后隐形失血量,且不会增加血栓事件的风险,且随着药物剂量的增加,其止血效果越强,同时具有更为显著的抗纤溶作用与抗炎效果。

Effects of High Doses of Tranexamic Acid on the Fibrinolytic Activity and Inflammatory Response of Patients undergoing Total Knee Arthroplasty

ABSTRACT Objective: To study the effect of high doses of tranexamic acid on the fibrinolytic activity and inflammatory response of patients undergoing total knee arthroplasty. Methods: 180 cases of patients with total knee in our hospital were retrospectively ana- lyzed, they were divided into the control group, regular group and large dosage group with 60 cases in each group according to the drug administration. The control group was treated with normal saline, conventional group was treated with and aminoacyclic acid, 10 mg/kg, large dose group was treated with aminoacyclic acid, 15 mg/kg. The total blood loss, hidden blood loss, changes of blood coagulation function (fibrinogen, prothrombin time, activated partial blood coagulation time live enzymes), fibrinolytic activity fibrin degradation products (FDP) (original), D - dimer] and inflammatory factor C - reactive protein (CRP) and interleukin 6 (IL - 6)] level preoperation and postoperation and incidence of thromboembolism events at 2 weeks after testing were compared among three groups. Results: The total blood loss and hidden blood loss of high-dose group and regular group were significantly lower than those of the control group, they were lower in the high-dose group than those of the regular group(P<0.05). There was no statistically significant difference in the fibrino- gen, the prothrombin time and the activated partial thrombin time between three groups(P>0.05). At 3 days after operation, the FDP and D-dimer, CRP, IL - 6 levels of high-dose group and regular group were significantly lower than those of the control group, they were low- er in the high-dose group than those of the regular group(P<0.05); At two weeks after surgery, there was no significant difference in the incidence of intramuscular venous thrombosis between three groups(P>0.05). Conclusion: Using tranexamic acid after total knee arthro- plast could further reduce the invisible blood loss, postoperative and do not increase the risk of thrombotic events, and with the increase of drug dose, the hemostatic effect is stronger, at the same time has more significant fibrinolytic function and anti-inflammatory effects.