黄亮达;魏亦兵;王思群;吴建国;黄钢勇;陈飞雁;陈杰;石晶晟;赵广雷;夏军;

• 1:复旦大学附属华山医院骨科

摘要(Abstract)：

全膝关节置换术仍未找到有效减少术后失血的方法,传统的止血带应用会破坏纤溶-凝血的平衡,不利于手术后伤口止血。氨甲环酸是一种纤溶抑制剂,能可逆地阻断纤溶酶原与纤维蛋白的结合,抑制纤维蛋白溶解,有效减少术后出血。但目前氨甲环酸的最佳治疗方案还未明确,关于血栓形成及栓塞事件的发生仍存在许多疑虑。该文就氨甲环酸作为止血药在全膝关节置换术中的作用、不同给药途径、剂量、剂次及安全性等方面的研究进展作一综述。

关键词(KeyWords)： 氨甲环酸;全膝关节置换术;失血量;输血

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 黄亮达;魏亦兵;王思群;吴建国;黄钢勇;陈飞雁;陈杰;石晶晟;赵广雷;夏军;

Email:

DOI:

参考文献(References)：

• [1]Callaghan JJ,O’Rourke MR,Liu SS.Blood management:issues and options[J].J Arthroplasty,2005,2:51-54.
• [2]Sehat KR,Evans RL,Newman JH.Hidden blood loss following hip and knee arthroplasty.Correct management of blood loss should take hidden loss into account[J].J Bone Joint Surg Br,2004,4:561-565.
• [3]Gascon P,Zoumbos NC,Young NS.Immunologic abnormalities in patients receiving multiple blood transfusions[J].Ann Intern Med,1984,2:173-177.
• [4]Fiebig E.Safety of the blood supply[J].Clin Orthop,1998,357:6-18.
• [5]Heddle NM,Klama LN,Griffith L,et al.A prospective study to identify the risk factors associated with acute reactions to platelet and red cell transfusions[J].Transfusion,1993,10:794-797.
• [6]Burkart BC,Bourne RB,Rorabeck CH,et al.The efficacy of tourniquet release in blood conservation after total knee arthroplasty[J].Clin Orthop,1994,299:147-152.
• [7]Skovgaard C,Holm B,Troelsen A,et al.No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty:a randomized,double-blind,placebo-controlled study[J].Acta Orthop,2013,2:153-158.
• [8]Newman ET,Watters TS,Lewis JS,et al.Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty[J].J Bone Joint Surg Am,2014,4:279-284.
• [9]Benoni G,Fredin H.Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty:a prospective,randomised,double-blind study of 86 patients[J].J Bone Joint Surg Br,1996,3:434-440.
• [10]Hoylaerts M,Lijnen HR,Collen D.Studies on the mechanism of the antifibrinolytic action of tranexamic acid[J].Biochim Biophys Acta,1981,1:75-85.
• [11]Verstraete M.Clinical application of inhibitors of fibrinolysis[J].Drugs,1985,3:236-261.
• [12]Nilsson IM.Clinical pharmacology of aminocaproic and tranexamic acids[J].J Clin Pathol Suppl(R Coll Pathol),1980,14:41-47.
• [13]Benoni G,Lethagen S,Fredin H.The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty[J].Thromb Res,1997,3:195-206.
• [14]Astedt B,Liedholm P,Wingerup L.The effect of tranexamic acid on the fibrinolytic activity of vein walls[J].Ann Chir Gynaecol,1978,6:203-205.
• [15]Yang ZG,Chen WP,Wu LD.Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis[J].J Bone Joint Surg Am,2012,13:1153-1159.
• [16]Alshryda S,Sarda P,Sukeik M,et al.Tranexamic acid in total knee replacement:a systematic review and meta-analysis[J].J Bone Joint Surg Br,2011,12:1577-1585.
• [17]Charoencholvanich K,Siriwattanasakul P.Tranexamic acid reduces blood loss and blood transfusion after TKA:a prospective randomized controlled trial[J].Clin Orthop,2011,10:2874-2880.
• [18]Chareancholvanich K,Siriwattanasakul P,Narkbunnam R,et al.Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty:a prospective randomized controlled trial[J].BMC Musculoskelet Disord,2012,13:124.
• [19]张瑜哲,金毅,苏礼,等.氨甲环酸减少初次单侧全膝关节置换术后失血量的临床研究[J].中国矫形外科杂志,2013,8:762-765.
• [20]Aguilera X,Videla S,Almenara M,et al.Effectiveness of tranexamic acid in revision total knee arthroplasty[J].Acta Orthop Belg,2012,1:68-74.
• [21]Chevet I,Remerand F,Couvret C,et al.Tranexamic acid reduces haematomas but not pain after total knee arthroplasty[J].Ann Fr Anesth Reanim,2011,1:17-24.
• [22]Zohar E,Fredman B,Ellis M,et al.A comparative study of the postoperative allogeneic blood-sparing effect of tranexamic acid versus acute normovolemic hemodilution after total knee replacement[J].Anesth Analg,1999,6:1382-1387.
• [23]Hiippala S,Strid L,Wennerstrand M,et al.Tranexamic acid(Cyklokapron)reduces perioperative blood loss associated with total knee arthroplasty[J].Br J Anaesth,1995,5:534-537.
• [24]Jansen AJ,Andreica S,Claeys M,et al.Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty[J].Br J Anaesth,1999,4:596-601.
• [25]Zohar E,Ellis M,Ifrach N,et al.The postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement[J].Anesth Analg,2004,6:1679-1683.
• [26]Engel JM,Hohaus T,Ruwoldt R,et al.Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin[J].Anesth Analg,2001,3:775-780.
• [27]Ido K,Neo M,Asada Y,et al.Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties[J].Arch Orthop Trauma Surg,2000,9:518-520.
• [28]Good L,Peterson E,Lisander B.Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement[J].Br J Anaesth,2003,5:596-599.
• [29]Camarasa MA,Olle G,Serra-Prat M,et al.Efficacy of aminocaproic,tranexamic acids in the control of bleeding during total knee replacement:a randomized clinical trial[J].Br J Anaesth,2006,5:576-582.
• [30]Molloy DO,Archbold HA,Ogonda L,et al.Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement:a prospective,randomised controlled trial[J].J Bone Joint Surg Br,2007,3:306-309.
• [31]Ellis MH,Fredman B,Zohar E,et al.The effect of tourniquet application,tranexamic acid,and desmopressin on the procoagulant and fibrinolytic systems during total knee replacement[J].J Clin Anesth,2001,7:509-513.
• [32]Alvarez JC,Santiveri FX,Ramos I,et al.Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied[J].Transfusion,2008,3:519-525.
• [33]Wong J,Abrishami A,El BH,et al.Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty:a randomized,controlled trial[J].J Bone Joint Surg Am,2010,15:2503-2513.
• [34]Roy SP,Tanki UF,Dutta A,et al.Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,12:2494-2501.
• [35]Mutsuzaki H,Ikeda K.Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty[J].J Orthop Surg Res,2012,7:32.
• [36]Ishida K,Tsumura N,Kitagawa A,et al.Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty[J].Int Orthop,2011,11:1639-1645.
• [37]Alshryda S,Mason J,Sarda P,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total hip replacement:a randomized controlled trial(TRANX-H)[J].J Bone Joint Surg Am,2013,21:1969-1974.
• [38]Maniar RN,Kumar G,Singhi T,et al.Most effective regimen of tranexamic acid in knee arthroplasty:a prospective randomized controlled study in 240 patients[J].Clin Orthop,2012,9:2605-2612.
• [39]McC onnell JS,Shewale S,Munro NA,et al.Reducing blood loss in primary knee arthroplasty:a prospective randomised controlled trial of tranexamic acid and fibrin spray[J].Knee,2012,4:295-298.
• [40]Ralley FE,Berta D,Binns V,et al.One intraoperative dose of tranexamic Acid for patients having primary hip or knee arthroplasty[J].Clin Orthop,2010,7:1905-1911.
• [41]Rajesparan K,Biant LC,Ahmad M,et al.The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement[J].J Bone Joint Surg Br,2009,6:776-783.
• [42]Iwai T,Tsuji S,Tomita T,et al.Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee arthroplasty[J].Int Orthop,2013,3:441-445.
• [43]Sepah YJ,Umer M,Ahmad T,et al.Use of tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement[J].J Orthop Surg Res,2011,6:22.
• [44]MacG illivray RG,Tarabichi SB,Hawari MF,et al.Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty:a prospective,randomized double blind study[J].J Arthroplasty,2011,1:24-28.
• [45]Lin PC,Hsu CH,Huang CC,et al.The blood-saving effect of tranexamic acid in minimally invasive total knee replacement:is an additional pre-operative injection effective[J].J Bone Joint Surg Br,2012,7:932-936.
• [46]Wind TC,Barfield WR,Moskal JT.The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty[J].J Arthroplasty,2013,7:1080-1083.
• [47]Gillette BP,DeS imone LJ,Trousdale RT,et al.Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty[J].Clin Orthop,2013,1:150-154.
• [48]傅德杰,陈凯宁,杨柳.氨甲环酸对全膝关节置换术失血量影响的系统评价[J].中国矫形外科杂志,2012,13:1172-1177.