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[1]錢(qián)濤,夏永法.老年全髖關(guān)節(jié)置換術(shù)中聯(lián)合應(yīng)用氨甲環(huán)酸和利伐沙班的臨床研究[J].中醫(yī)正骨,2019,31(01):10-13.
　QIAN Tao,XIA Yongfa.A clinical study of combined application of tranexamic acid and rivaroxaban in total hip arthroplasty in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(01):10-13.
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老年全髖關(guān)節(jié)置換術(shù)中聯(lián)合應(yīng)用氨甲環(huán)酸和利伐沙班的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年01期
頁(yè)碼:
10-13
欄目:
臨床研究
出版日期:
2019-01-20

文章信息/Info

Title:
A clinical study of combined application of tranexamic acid and rivaroxaban in total hip arthroplasty in the aged
作者:
錢(qián)濤; 夏永法
(安吉縣中醫(yī)醫(yī)院,浙江 安吉 313300)
Author(s):
QIAN Tao; XIA Yongfa
Anji Hospital of Traditional Chinese Medicine,Anji 313300,Zhejiang,China
關(guān)鍵詞:
關(guān)節(jié)成形術(shù); 置換; 髖;  失血; 手術(shù);  氨甲環(huán)酸;  利伐沙班;  靜脈血栓形成;  肺栓塞;  老年人;  臨床試驗(yàn)
Keywords:
arthroplasty; replacement; hip;  blood loss; surgical;  tranexamic acid;  rivaroxaban;  venous thrombosis;  pulmonary embolism;  aged;  clinical trial
摘要:
目的:觀察老年全髖關(guān)節(jié)置換術(shù)中聯(lián)合應(yīng)用氨甲環(huán)酸和利伐沙班的臨床療效和安全性。方法:將70例初次接受單側(cè)全髖關(guān)節(jié)置換手術(shù)的患者隨機(jī)分為2組,每組35例。由同一組醫(yī)生對(duì)所有患者實(shí)施全髖關(guān)節(jié)置換術(shù),采用全身麻醉或腰硬聯(lián)合麻醉,均選用前外側(cè)入路。術(shù)中關(guān)閉關(guān)節(jié)腔后,聯(lián)合組經(jīng)引流管向關(guān)節(jié)腔內(nèi)注入10%氨甲環(huán)酸注射液20 mL,利伐沙班組經(jīng)引流管向關(guān)節(jié)腔內(nèi)注入生理鹽水20 mL,夾閉6 h后打開(kāi)引流管。術(shù)后6 h,聯(lián)合組將適量氨甲環(huán)酸注射液(10 mg·kg-1)稀釋于100 mL生理鹽水中靜脈滴注,利伐沙班組靜脈滴注100 mL生理鹽水。2組患者均于術(shù)后6 h開(kāi)始口服利伐沙班片,每次10 mg,每天1 次,共服用5周。比較2組患者的顯性紅細(xì)胞丟失量和隱性紅細(xì)胞丟失量,同時(shí)觀察術(shù)后3個(gè)月內(nèi)肺栓塞發(fā)生情況及下肢深靜脈血栓形成情況。結(jié)果:聯(lián)合組有6例患者輸血,利伐沙班組有8例患者輸血。2組的輸血率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.357,P=0.550)。聯(lián)合組的顯性紅細(xì)胞丟失量和隱性紅細(xì)胞丟失量均低于利伐沙班組[(215.00±42.00)mL,(277.00±51.00)mL,t=5.552,P=0.000;(247.00±35.00)mL,(360.00±43.00)mL,t=12.507,P=0.000]。術(shù)后3個(gè)月內(nèi)2組患者均未發(fā)生肺栓塞和下肢深靜脈血栓。結(jié)論:在老年全髖關(guān)節(jié)置換手術(shù)中聯(lián)合應(yīng)用氨甲環(huán)酸和利伐沙班可以有效減少出血,而且短期內(nèi)不會(huì)增加肺栓塞和下肢深靜脈血栓形成的風(fēng)險(xiǎn)。
Abstract:
Objective:To observe the clinical curative effects and safety of combined application of tranexamic acid and rivaroxaban in total hip arthroplasty(THA)in the aged.Methods:Seventy patients were treated with primary unilateral THA and were randomly divided into combination group and rivaroxaban group,35 cases in each group.THA was performed through anterolateral approach by the same group of surgeons under general anesthesia or combined spinal-epidural anesthesia.After the articular cavity was closed in the sugery,10% tranexamic acid injection(20 mL)was injected into articular cavity through drainage tube in combination group,while the same dose of normal saline(NS)was injected into articular cavity through drainage tube in rivaroxaban group.The drainage tube was closed for 6 hours.At 6 hours after the surgery,the patients in combination group were treated with intravenous drip of tranexamic acid injection(10 mg/kg)dissolved in 100 mL of NS,while the patients in rivaroxaban group were treated with intravenous drip of 100 mL of NS.All patients were treated with oral application of rivaroxaban tablets since the 6th hour after the surgery,once a day,10 mg at a time for 5 consecutive weeks.The dominant erythrocyte loss and hidden erythrocyte loss were compared between the 2 groups,meanwhile,the complications such as pulmonary embolism(PE)and lower extremity deep venous thrombosis(DVT)were observed within 3 months after the surgery.Results:Blood transfusions were performed on 6 patients in combination group and 8 patients in rivaroxaban group.There was no statistical difference in the blood transfusion rate between the 2 groups(χ2=0.357,P=0.550).The dominant erythrocyte loss and hidden erythrocyte loss were lower in combination group compared to rivaroxaban group(215.00+/-42.00 vs 277.00+/-51.00 mL,t=5.552,P=0.000; 247.00+/-35.00 vs 360.00+/-43.00 mL,t=12.507,P=0.000).No PE and lower extremity DVT were found in both of the 2 groups within 3 months after surgery.Conclusion:Combined application of tranexamic acid and rivaroxaban can effectively reduce blood loss in aged patients who received THA,while the risks of PE and lower extremity DVT won't increase in short term.

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通訊作者:錢(qián)濤 E-mail:[email protected]
更新日期/Last Update: 2019-07-11