氨甲环酸于合并致静脉血栓栓塞事件形成高危并存疾病全膝置换的安全性和有效性

邹春雨; 岳辰; 杨澜波; 米豫飞; 王战朝

doi:10.16766/j.cnki.issn.1674-4152.001945

氨甲环酸于合并致静脉血栓栓塞事件形成高危并存疾病全膝置换的安全性和有效性

doi: 10.16766/j.cnki.issn.1674-4152.001945

河南省洛阳正骨医院(河南省骨科医院)膝部疾病研究治疗中心，河南洛阳 471000

基金项目:

国家自然科学基金 81804126

详细信息

通讯作者:
王战朝, E-mail: wangzc63@sina.com

中图分类号: R687.4 R973.1
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- 文章访问数: 233
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- 被引次数: 0
出版历程
- 收稿日期: 2020-07-06
- 网络出版日期: 2022-02-16

Safety and effectiveness of tranexamic acid in patients combined with high risk comorbidities for postoperative venous thromboembolism during total knee arthroplasty

Treatment Center of the Knee, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, Henan 471000, China

摘要

摘要: 目的评价氨甲环酸(tranexamic acid，TXA)于合并致静脉血栓栓塞事件(venous thromboembolism, VTE)形成高危并存疾病全膝关节置换(total knee arthroplasty, TKA)患者中应用的安全性和有效性。方法设定致TKA术后VTE形成风险增加的8个术前并存疾病，据此回顾河南省洛阳正骨医院2010年1月—2019年12月收治的初次单侧TKA患者资料，并根据氨甲环酸使用方法分为对照组、静脉TXA组、局部TXA组。安全性指标为VTE发生率，有效性指标为输血率。结果共回顾7 836例TKA，其中合并致VTE形成高危并存疾病的共781例。对照组341例，静脉TXA组163例，局部TXA组277例。对照组29例(8.50%)、静脉组16例(9.82%)、局部组22例(7.94%)发生术后VTE，组间比较差异无统计学意义。静脉TXA组(18.40%)及局部TXA组(22.38%)输血率明显较对照组(31.67%)低，差异有统计学意义(P=0.002)。结论静脉及局部TXA均不增加合并致VTE高危并存疾病TKA患者围术期VTE发生风险，且能有效降低输血率，TXA于此类TKA患者中应用安全有效。
- 氨甲环酸 /
- 并存疾病 /
- 静脉血栓栓塞事件 /
- 全膝关节置换术
Abstract: Objective To assess the safety and efficacy of tranexamic acid (TXA) in patients with high risk comorbidities for venous thromboembolic events (VTE) during total knee arthroplasty (TKA). Methods We chose eight risk factors for postoperative VTE during TKA. Patients in Luoyang Orthopedic Hospital of Henan Province were reviewed from January 2010 to December 2019 and were divided into control, intravenous TXA, and topical TXA group. The safety outcomes were identified as the incidence of VTE, and the efficacy outcome was limited to transfusions. Results Through a comprehensive review of 7 836 consecutive TKA cases from 2010 to 2019, 781 cases were included according to the inclusion criteria. Of them, 341 cases didn't receive TXA, 163 patients received intravenous TXA and 277 patients received topical TXA. The incidence of VTE was not significant difference across these three groups (8.50% vs. 9.82% vs. 7.94%), and the transfusion rate was significantly lower in the intravenous and topical TXA groups than the control group (31.67% vs. 18.40% vs. 22.38%, P=0.002). Conclusion This study preliminary showed that TXA was effective to decrease transfusions without sacrificing the safety in patients with high risk comorbidities for VTE during TKA.
- Tranexamic acid /
- Comorbidity /
- Venous thromboembolism /
- Total knee arthroplasty

HTML全文

表 1 3组TKA患者基线指标比较 (x ±s)

组别	例数	年龄(岁)	性别 (男/女, 例)	BMI	术前血红蛋白(g/L)	致VTE高危并存疾病(SPC/CPC, 例)
对照组	341	66.5±12.8	150/191	26.0±3.4	123.6±13.5	279/62
静脉组	163	68.5±11.2	72/91	25.5±3.9	124.4±14.5	130/33
局部组	277	67.1±10.3	129/148	26.2±4.2	125.9±11.8	226/51
统计量		1.355^a	0.461^b	2.272^a	2.287^a	0.332^b
P值		0.259	0.794	0.104	0.102	0.847
注：^a为F值，^b为χ²值。

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表 2 3组TKA患者安全性结果比较 [例(%)]

组别	例数	整体VTE	DVT	PDVT	DDVT	SPE
对照组	341	29(8.50)	27(7.92)	7(2.05)	20(5.87)	2(0.59)
静脉组	163	16(9.82)	16(9.82)	5(3.07)	11(6.75)	0(0.00)
局部组	277	22(7.94)	20(7.22)	3(1.08)	17(6.14)	2(0.72)
χ²值		0.464	0.950	2.201	0.149	1.120
P值		0.793	0.622	0.333	0.928	0.572

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表 3 3组TKA患者安全性结果(VTE发生率)的分层分析 (%)

组别	例数	SPC	CPC
对照组	341	7.88(22/279)	11.29(7/62)
静脉组	163	9.23(12/130)	12.12(4/33)
局部组	277	7.52(17/226)	9.80(5/51)
χ²值		0.301	0.122
P值		0.843	0.941

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