下肢关节置换术围术期氨甲环酸的应用：多中心前瞻性队列研究
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Peri-operative administration of tranexamic acid in lower limb arthroplasty: a multicentre, prospective cohort study
背景与目的
在英国，所有预期失血量超过500ml的外科手术，均推荐使用氨甲环酸。但是，氨甲环酸的最佳剂量、给药途径和给药时间尚不清楚。本研究旨在评估围术期氨甲环酸的应用现状。
方 法
本项前瞻性研究纳入2周内接受首次全髋关节置换术、全膝关节置换术或膝关节单髁置换术的患者。主要观察结果是围术期接受氨甲环酸的患者比例。次要结果包括氨甲环酸的给药剂量、途径和时间；术前和术后贫血的发病率；预估失血量；红细胞输注率。
结 果
我们共从56家NHS医院收集了1701名患者。这些患者中，1523例（89.5%）患者接受了氨甲环酸治疗，其中1052例（69.1%）在术前或术中单次静脉注射氨甲环酸1000mg。1701例患者中，分别有571例（33.6%）和1386例（81.5%）在术前和术后出现贫血（血红蛋白<130g·L-1）。所有入选患者的平均（SD）预估失血量为792（453）ml，54名患者（3.1%）术后输注了红细胞。术前贫血患者的输血率为6.5%，而非贫血患者的输血率为1.5%。
结 论
英国目前的治疗标准是术前或术中静脉注射1000 mg氨甲环酸。尽管总的红细胞输注率较低，但约有三分之一的手术患者出现贫血。这些数据为今后研究评估氨甲环酸和其它的患者血液管理干预措施的疗效提供了有价值的参考。
原始文献来源及摘要
Lloyd TD, Neal-Smith G, Fennelly J, et al. Peri-operative administration of tranexamic acid in lower limb arthroplasty: a multicentre, prospective cohort study.[J]. Anaesthesia. 2020 Jun 4. doi: 10.1111/anae.15056.
Summary
In the UK, tranexamic acid is recommended for all surgical procedures where expected blood loss exceeds 500 ml. However, the optimal dose, route and timing of administration are not known. This study aimed to evaluate current practice of peri-operative tranexamic acid administration.
Patients undergoing primary total hip arthroplasty, total knee arthroplasty or unicompartmental knee arthroplasty during a 2-week period were eligible for inclusion in this prospective study. The primary outcome was the proportion of patients receiving tranexamic acid in the peri-operative period. Secondary outcomes included: dose, route and timing of tranexamic acid administration; prevalence of pre- and postoperative anaemia; estimated blood loss; and red blood cell transfusion rates.
In total, we recruited 1701 patients from 56 NHS hospitals. Out of these, 1523 (89.5%) patients received tranexamic acid and of those, 1052 (69.1%) received a single dose of 1000 mg intravenously either pre- or intra-operatively. Out of the 1701 patients, 571 (33.6%) and 1386 (81.5%) patients were anaemic (haemoglobin < 130 g·L-1 ) in the pre- and postoperative period, respectively. Mean (SD) estimated blood loss for all included patients was 792 (453) ml and 54 patients (3.1%) received a red blood cell transfusion postoperatively. The transfusion rate for patients with pre-operative anaemia was 6.5%, compared with 1.5% in patients without anaemia.
Current standard of care in the UK is to administer 1000 mg of tranexamic intravenously either pre- or intra-operatively. Approximately one-third of patients present for surgery with anaemia, although the overall red blood cell transfusion rate is low. These data provide useful comparators when assessing the efficacy of tranexamic acid and other patient blood management interventions in future studies.
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贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：曹莹