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目的:探讨氨甲环酸(TXA)应用剂量对初次单侧全膝关节置换(TKA)患者围手术期失血量及输血量的影响.方法:选择2015-03-2016-03霸州市第二医院行初次单侧TKA的骨关节炎患者123例,随机分为对照组、低剂量组及高剂量组,每组41例.对照组关闭切口前静脉滴注生理盐水;低剂量组关闭切口前静脉滴注TXA 10 mg/kg;高剂量组关闭切口前静脉滴注TXA15 mg/kg.观察和比较3组患者术后血红蛋白(Hb)水平、围手术期总失血量、显性失血量、隐性失血量、异体输血量以及术后深静脉血栓和肺栓塞发生率.结果:①3组患者术后Hb水平与术前比较均有明显下降(P＜0.05),但低剂量组和高剂量组术后第1、3、5天的Hb水平明显高于对照组,差异有统计学意义(P＜0.05);②低剂量组和高剂量组的总失血量、显性失血量、隐性失血量、异体输血量明显少于对照组,差异比较有统计学意义(P＜0.05);高剂量组总失血量、隐性失血量、异体输血量明显少于低剂量组,差异比较有统计学意义(P＜0.05);③3组患者术后均无深静脉血栓及肺栓塞发生.结论:在TKA手术中静脉使用TXA能够有效减少围手术期失血量和输血量,提高术后Hb水平,按15 mg/kg剂量输注能进一步减少隐性失血,且不增加深静脉血栓和肺栓塞的发生风险.“,”Objective:To explore the influence of larger doses of tranexamic acid (TXA) on perioperative blood loss in primary unilateral total knee arthroplasty (TKA).Method:123 cases of osteoarthritis patients who received primary unilateral TKA in the Second Hospital of Bazhou City from March 2015 to March 2016 were enrolled in this study,and randomly assigned to control group,low dose group and high dose group,41 cases in each group.The patients in control group,low dose group and high dose group were received physiological saline,10 mg/kg TXA and 15 mg/kg TXA respectively via fast intravenous infusion before closing the incision.Postoperative Hb levels,perioperative total blood loss,dominant amount of blood loss,hidden blood loss,allogeneic blood transfusion and the incidence of postoperative deep vein thrombosis and pulmonary embolism in three groups were observed and compared.Result:①Compared with the preoperative,the postoperative Hb levels were significantly lower (P＜0.05) in three groups,and the Hb levels at postoperative 1 d,3 d,5 d in low dose group and high dose group were higher than those in control group,the differences were statistically significant (P＜0.05).②The total blood loss,dominant amount of blood loss,hidden blood loss,allogeneic blood transfusion in low dose group and high dose group were significantly less than those in control group,the differences had statistical significance (P＜0.05).The total blood loss,hidden blood loss,allogeneic blood transfusion in high dose group were significantly less than those in low dose group,the differences had statistical significance (P＜0.05).③No postoperative deep vein thrombosis or pulmonary embolism was found in three groups.Conclusion:TXA can reduce effectively the perioperative blood loss and transfusion volume and increase the postoperative hemoglobin level in patients with TKA.15 mg/kg of TXA would be more effective in reducing hidden blood loss and do not increase the risk of deep vein thrombosis and pulmonary embolism.