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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2025, Vol. 11 ›› Issue (06) : 321 -328. doi: 10.3877/cma.j.issn.2096-0263.2025.06.001

膝关节

氨甲环酸和氨基己酸在全膝关节置换术围手术期止血效果和药物安全性对比
张客松, 侯卫坤, 宇文星, 鲁超†()   
  1. 710054　西安市红会医院关节外科
  • 收稿日期:2025-05-31 出版日期:2025-12-05
  • 通信作者: 鲁超
  • 基金资助:
    陕西省卫生健康骨关节疾病智能及精准治疗科研创新平台(2024 PT-13)

Comparison of hemostatic effect and drug safety between tranexamic acid and aminocaproic acid during perioperative period of Total Knee Arthroplasty

Kesong Zhang, Weikun Hou, Xing Yuwen, Chao Lu†()   

  1. Department of joint surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, China
  • Received:2025-05-31 Published:2025-12-05
  • Corresponding author: Chao Lu
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引用本文：

张客松, 侯卫坤, 宇文星, 鲁超. 氨甲环酸和氨基己酸在全膝关节置换术围手术期止血效果和药物安全性对比[J/OL]. 中华老年骨科与康复电子杂志, 2025, 11(06): 321-328.

Kesong Zhang, Weikun Hou, Xing Yuwen, Chao Lu. Comparison of hemostatic effect and drug safety between tranexamic acid and aminocaproic acid during perioperative period of Total Knee Arthroplasty[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2025, 11(06): 321-328.

目的

抗纤溶药物例如氨甲环酸和氨基己酸被证实可以有效减少全膝关节置换术的围手术期失血量。本研究旨在对比氨甲环酸和氨基己酸在全膝关节置换术中的止血效果和药物安全性。

方法

回顾性分析2023年08月至2024年02月间，就诊于西安市红会医院行单侧全膝关节置换术的196例患者。其中男性50例，女性146例，平均年龄（66.5±7.5）岁。根据应用抗纤溶药物的不同，分为氨甲环酸组98例和氨基己酸组98例，给药方式均静脉输液联合关节腔注射，所有患者术后均未放置引流管。通过对比两组患者围手术期失血量、输血率、血红蛋白下降值等，比较两种药物的止血效能。通过对比伤口渗血、下肢深静脉血栓形成、肺栓塞和关节假体周围感染等并发症发生率来比较两种药物安全性。统计两组患者术后随访膝关节协会评分、膝关节屈曲活动度和视觉模拟评分，对比膝关节功能。

结果

196例患者获得随访，所有患者随访时间均为术后3个月。氨甲环酸组血红蛋白平均下降20.0（12.0，32.5）g/L，相比氨基己酸组的25.0（16.8,34.5）g/L，差异无统计学意义（P=0.072）。氨甲环酸组围手术期失血量为（746.9±490.7）ml，同样显著低于氨基己酸组的（918.6±371.4）ml（P=0.012）。氨甲环酸组围手术期输血率为1.0%，对比氨基己酸组的3.1%，差异无统计学意义（P=0.313）。两组患者假体周围感染和下肢深静脉血栓发生率均为1.0 %，随访期间两组患者未发现肺栓塞。氨甲环酸组末次随访视觉模拟评分，2.0（0.0，2.0）分，显著高于氨基己酸组的2.0（0.0，2.0）分（P=0.005）。相比氨基己酸组的（109.6±11.9）°，氨甲环酸组膝关节屈曲活动度为（107.9±12.3）°，组间差异无统计学意义（P=0.262）。氨甲环酸组随访膝关节协会评分为（78.4±15.6）分，对比氨基己酸组的（77.9±15.9）分，差异无统计学意义（P=0.807）。

结论

本研究发现在初次全膝关节置换术中，应用氨甲环酸的止血效果明显优于氨基己酸。氨甲环酸组失血量更少，输血率更低。两组并发症发生率方面较为接近。因此，氨甲环酸被推荐为全膝关节置换术围手术期首选的抗纤溶药物。

关键词: 氨甲环酸, 氨基己酸, 抗纤溶药物, 全膝关节置换术, 不良反应
Objective

Antifibrinolytic drugs such as tranexamic acid (TXA) and aminocaproic acid (EACA) have been proved could effectively reduce perioperative blood loss in total knee arthroplasty (TKA). The aim of this study is to compare hemostatic effect and drug safety of TXA and EACA in TKA.

Methods

A total of 196 patients who underwent unilateral TKA at Xi'an Honghui Hospital were retrospectively analyzed from August 2023 to February 2024. Among them, there were 50 males and 146 females, with an average age of 66.5±7.5 years. According to the different usage of antifibrinolytic drugs, patients were divided into the TXA group (n=98) and the EACA group (n=98). The administration method of drug was intravenous transfusion combined with intra-articular injection. There was no drainage tube placed for each patient after surgery. Hemostatic efficacy of these two drugs were compared by contrasting perioperative blood loss, transfusion rate, and decline of hemoglobin between two groups of patients. Drug safety was also compared by analyzing complications such as wound bleeding, deep vein thrombosis (DVT), pulmonary embolism (PE), and periprosthetic joint infection (PJI). Knee Society Score (KSS), flexion range of knee and visual analog scale (VAS) of two groups were analyzed to compare knee joint function.

Results

A total of 196 patients was followed up for 3 months after surgery. The mean decline of hemoglobin in TXA group was 20.0(12.0, 32.5) g/L, no significant deffierence compared with 25.0(16.8, 34.5)g/L of EACA group (P=0.072). In terms of perioperative blood loss, TXA group was also significantly lower than the EACA group (746.9±490.7 and 918.6±371.4 ml, P=0.012). Perioperative transfusion rate of TXA group was 1. 0%, no significant difference compared to 3.1% in EACA group (P=0.313). The incidence of periprosthetic infection (PJI) and deep vein thrombosis (DVT) in each group of patients was 1.0%. No pulmonary embolism were found in each group during follow-up period. The VAS score of TXA group was 2.0(0.0, 2.0) at last follow-up, which was significantly higher than 2.0(0.0, 2.0) EACA group (P=0.005). There was no significant difference in knee flexion range between TXA group (107.9±12.3)° and EACA group (109.6±11.9)° (P=0.262). The KSS of TXA group was 78.4±15.6 at last follow-up. There was no significant difference compared to 77.9±15.9 of EACA group (P=0.807).

Conclusions

It was found in this study that hemostatic effect of TXA was significantly better than EACA in primary TKA. TXA group had less amount of blood loss and lower transfusion rate. The incidence of complications between these two groups were relatively approximated. Thus, TXA was recommended as preferred anti fibrinolytic drug in perioperative period of TKA.

Key words: Tranexamic acid, Aminocaproic acid, Antifibrinolytic drugs, Total knee replacement surgery, Adverse reaction
表1 氨甲环酸组和氨基己酸组全膝关节置换术患者一般信息比较
指标 氨甲环酸组（n=98） 氨基己酸组（n=98） t值/χ2值 P值
年龄（岁，±s） 66.8±8.1 66.1±7.2 0.626 0.522
身高（cm，±s） 160.2±6.6 162.0±7.4 -1.707 0.093
体重（kg，±s） 64.8±10.3 68.4±11.1 -2.349 0.019
BMI（kg/m2，±s） 25.3±3.7 26.0±3.1 -1.503 0.138
性别（例，男/女） 23/75 27/71 0.432 0.508
侧别（例，左/右） 56/42 55/43 0.020 0.887
病因（例）        
骨关节炎 89 93    
类风湿性关节炎 3 3 2.086 0.350
大骨节病 6 2    
ASA分级（例）    
Ⅱ级 53 60 1.016 0.283
Ⅲ级 45 38    
手术时间（min，±s） 89.4±19.3 85.3±14.3 1.564 0.118
止血带时间（min，±s） 53.5±14.1 52.2±12.3 0.692 0.487
表2 氨甲环酸组和氨基己酸组全膝关节置换术患者功能评分对比
指标 氨甲环酸组 氨基己酸组 Z值/t值 P值
术前KSS评分（分，±s） 45.3±12.4 44.8±11.9 -0.286 0.773
随访KSS评分（分，±s） 78.4±15.6 77.9±15.9 -0.241 0.807
术前最大屈曲（°，±s） 98.6±10.5 99.2±11.3 -0.323 0.746
随访最大屈曲（°，±s） 107.9±12.3 109.6±11.9 -1.128 0.262
术前VAS[分，M（Q1,Q3）] 0.0（0.0，2.0） 0.0（0.0，2.0） -1.218 0.200
随访VAS[分，M（Q1,Q3）] 2.0（0.0，2.0） 2.0（0.0，2.0） -2.781 0.005
术前Caprini评分（分，±s） 2.1±1.2 2.1±0.9 -0.203 0.837
术后Caprini评分（分，±s） 7.2±1.1 7.5±1.1 -1.529 0.127
术后住院日（d，±s） 4.2±1.1 4.5±0.8 -1.654 0.103
表3 氨甲环酸组和氨基己酸组全膝关节置换术患者实验室检查指标对比
指标 项目 氨甲环酸组 氨基己酸组 Z值/t值/χ2值 P值
术前凝血功能 D-二聚体[M（Q1,Q3）] 0.43（0.33，0.57） 0.44（0.35，0.68） -0.928 0.353
  国际标准化比值（±s） 0.98±0.06 0.96±0.06 2.262 0.026
血常规指标 术前血红蛋白（g/L，±s） 129.9±13.4 129.9±14.5 -0.017 0.987
  术后血红蛋白（g/L，±s） 108.3±12.0 103.2±12.4 2.933 0.004
  血红蛋白下降[g/L，M（Q1,Q3）] 20.0（12.0，32.5） 25.0（16.8，34.5） -1.798 0.072
  术前红细胞比容（%，±s） 39.7±3.6 39.9±3.6 -0.239 0.812
  术后红细胞比容（%，±s） 32.9±3.0 31.7±3.5 2.477 0.012
  术前血小板计数（109/L，±s） 204.8±53.1 216.5±65.3 -1.365 0.174
  术后血小板计数（109/L，±s） 174.5±50.0 175.4±53.3 -0.123 0.909
  血小板计数下降[109/L，M（Q1,Q3）] 31.0（18.0，43.3） 40.0（18.0，58.3） -2.651 0.008
失血指标 估算血容量（ml，±s） 3 897.3±537.2 4 049.5±622.9 -1.817 0.072
  估算失血量（ml，±s） 746.9±490.7 918.6±371.4 -2.746 0.012
  失血占血容量比例（%，±s） 18.9±11.2 22.9±12.0 - 0.011
  围手术期输血率（%） 1.0% 3.1% 1.019 0.313
肾功能指标 术前血肌酐（μmol/L，±s） 58.9±19.3 57.0±13.3 0.786 0.136
  术后血肌酐（μmol/L，±s） 59.8±19.7 59.0±14.2 0.322 0.748
  术前尿素氮（mmol/L，±s） 5.4±1.7 5.6±1.5 -0.771 0.438
  术后尿素氮（mmol/L，±s） 4.7±1.5 5.3±1.6 -2.583 0.014
表4 氨甲环酸组和氨基己酸组全膝关节置换术患者并发症对比
并发症 氨甲环酸组[例（%）] 氨基己酸组[例（%）] χ2值 P值
伤口渗血 3（3.1） 5（5.1） 0.523 0.466
下肢静脉血栓 1（1.0） 1（1.0） - 1.000
肺栓塞 0 0 - 1.000
假体周围感染 1（1.0） 1（1.0） - 1.000
转入内科 1（1.0） 0 - 1.000
转入ICU 1（1.0） 0 - 1.000
30 d内再入院率原因 3（3.1） 1（1.0） 1.019 0.312
膝关节僵硬 2（2.0） 0    
顽固性膝关节疼痛 1（1.0） 0    
假体周围感染 0 1（1.0）    
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