探讨氨甲环酸（TXA）在减少初次接受人工全髋关节置换术（THA）治疗的肥胖症患者围手术期失血中的应用价值。

回顾性分析2014年11月至2015年6月因股骨头缺血性坏死在江门市五邑中医院骨伤科二区初次接受THA治疗的80例肥胖症患者的临床资料。所有患者均签署知情同意书，符合医学伦理学规定。根据围手术期是否使用TXA将患者分为TXA和非TXA组。其中TXA组40例，男18例，女22例；平均年龄（59±4）岁。非TXA组40例，男26例，女14例；平均年龄（58±3）岁。TXA组患者于切皮前15 min用氨甲环酸20 mg/kg缓慢静脉滴注，并在缝合皮肤前将3 g氨甲环酸稀释于50 ml生理盐水再经引流管逆行注入切口。非TXA组以等量生理盐水替代氨甲环酸。比较两组患者术前体质量，身高，术中出血量，术后引流量，输血率，术前和术后1、3 d的血常规，总失血量和隐形失血量等指标。两组资料的比较采用t检验和χ²检验。

TXA组患者的总失血量、术后引流量、隐性失血量和输血率分别为（667±219）ml、（247±129）ml、（268±192）ml和22.5%（9/40），均明显低于非TXA组的（1217±493）ml、（519±252）ml、（591±298）ml和67.5%（27/40）（t=6.448、6.077、5.763、16.364，P<0.05）；两组患者术后血红蛋白水平均较术前下降，但TXA组患者术后1和3 d的平均血红蛋白分别为（103±16）和（95±12）g/L，均明显高于非TXA组的（92±15）和（84±10）g/L（t=3.438、4.436，P<0.05）；两组患者深静脉血栓形成率比较差异无统计学意义（χ²=0.353，P>0.05）。

氨甲环酸能明显减少初次接受THA治疗的肥胖症患者围手术期的失血量，且不增加深静脉血栓形成和肺栓塞的发生风险，故可在临床上推广使用。

To investigate the application value of tranexamic acid (TXA) in reducing perioperative blood loss of obese patients undergoing primary total hip arthroplasty (THA).

Clinical data of 80 obese patients undergoing primary THA because of ischemic necrosis of femoral head in Department Two of Orthopedics, Wuyi Traditional Chinese Medicine Hospital of Jiangmen from November 2014 to June 2015 were retrospectively studied. The informed consents of all women were obtained and the local ethical committee approval had been received. According to whether TXA was used in perioperative period, those patients were divided into the TXA group and the non-TXA group. Forty patients were included into the TXA group, of whom 18 were males and 22 were females with an average age of (59±4) years old. Forty patients were included into the non-TXA group, of whom 26 were males and 14 were females with an average age of (58±3) years old. TXA was used in the TXA group patients: they were given 20 mg/kg TXA by intravenous administration 15 minutes before skin incision, and 3 g TXA which was diluted into 50 ml with normal saline and then retrograde injected through drainage tube before skin suture. The patients in the non-TXA group were given normal saline of the same dose instead. The indexes of body weight, height, intraoperative blood loss, postoperative suction drainage, rate of blood transfusion, blood routine examination before and 1 and 3 d after operation, total blood loss and hidden blood loss were compared between the two groups. Comparisons of the data were conducted using t test and χ² test.

The total blood loss, postoperative suction drainage, hidden blood loss and rate of blood transfusion of the patients in the TXA group were (667±219) ml, (247±129) ml, (268±192) ml and 22.5% (9/40) respectively, which were significantly lower than (1217±493) ml, (519±252) ml, (591±298) ml and 67.5% (27/40) of those patients in the non-TXA group (t=6.448, 6.077, 5.763, 16.364, P<0.05); the hemoglobin levels of both the two groups were lower than those before surgery respectively, but the hemoglobin levels of the patients in the TXA group were (103±16) and (95±12) g/L at 1 and 3 d after operation respectively, which were significantly higher than (92±15) and (84±10) g/L of the patients in the non-TXA group (t=3.438, 4.436, P<0.05); there was no statistical difference in the rate of deep venous thrombosis between the two groups (χ²=0.353, P>0.05).

TXA can reduce perioperative blood loss of obese patients undergoing primary THA, and do not increase the risk of deep vein thrombosis and pulmonary embolism, so it’s worthy of clinical promotion and application.