中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (9): 2361-2369.doi: 10.12307/2026.587

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

氨甲环酸与氨基己酸在全髋和全膝关节置换过程中有效性和安全性的Meta分析

何易祥1，乔万佳1，王文己1，2   

  1. 1兰州大学第一临床医学院，甘肃省兰州市  730000；2兰州大学第一医院骨科，甘肃省兰州市  730000
  • 收稿日期:2024-12-02 接受日期:2025-03-14 出版日期:2026-03-28 发布日期:2025-09-29
  • 通讯作者: 王文己，教授，主任医师，博士生导师，兰州大学第一临床医学院，甘肃省兰州市 730000；兰州大学第一医院骨科，甘肃省兰州市 730000
  • 作者简介:何易祥，男，1995年生，兰州大学第一临床医学院在读博士，主要从事关节外科、骨坏死修复方面的研究。

Effectiveness and safety of tranexamic acid versus epsilon-aminocaproic acid in total hip and knee arthroplasties: a meta-analysis

He Yixiang1, Qiao Wanjia1, Wang Wenji1, 2   

  1. 1First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China; 2Department of Orthopedics, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
  • Received:2024-12-02 Accepted:2025-03-14 Online:2026-03-28 Published:2025-09-29
  • Contact: Wang Wenji, Professor, Chief physician, Doctoral supervisor, First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China; Department of Orthopedics, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
  • About author:He Yixiang, Doctoral candidate, First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China

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摘要：

文题释义：

抗纤溶药物：是一类通过竞争性占据纤溶酶原和纤溶酶上的赖氨酸结合点，阻断纤溶酶原与纤维蛋白的结合，从而抑制纤溶酶的形成，减少出血的药物。常用的抗纤溶药物包括有氨甲环酸、氨基己酸、抑肽酶等。抗纤溶药物在减少出血的同时，还能通过保护纤溶抑制物、减少炎症反应等方式，进一步发挥止血和血液保护的作用。
关节置换：是一种通过外科手术将人工制造的关节假体置入人体，以替代严重受损关节的手术方式。可缓解患者因关节病变导致的关节疼痛、矫正关节畸形、恢复和改善关节的运动功能，提高患者的生活质量，其手术部位常见于髋关节、膝关节和肩关节等部位。

摘要
目的：氨甲环酸和氨基己酸是广泛用于骨科手术的止血药物。然而，两者在全关节置换止血疗效的比较研究仍然较少。此次研究旨在系统评价两种药物在全髋关节置换和全膝关节置换过程中的有效性和安全性。
方法：从PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库中检索建库至2024-11-01已正式发表的有关氨甲环酸和氨基己酸在全膝关节置换或全髋关节置换围术期应用的相关研究。去除重复文献后，由2名研究人员根据纳入及排除标准独立进行文献筛选和数据提取。采用Review Manager 5.3软件对总失血量、输血率、深静脉血栓发生率等结局指标进行统计分析。
结果：此次Meta分析最终纳入包含4 101例患者的7项随机对照试验和5项非随机对照试验；在全髋关节置换及全膝关节置换过程中，与氨基己酸相比，氨甲环酸可明显降低患者总失血量(MD=-109.58，95%CI：-169.08至-50.07，P < 0.001)、术后引流量(MD=-35.66，95%CI：-64.99至-6.33，P=0.02)和血红蛋白丢失量(MD=-0.25，95%CI：-0.40至-0.09，P=0.002)，且差异均有显著性意义；但两组患者在术中出血量、手术时间、住院时间、输血率、每例患者输血单位及深静脉血栓发生率等方面相比差异均无显著性意义(P > 0.05)。
结论：Meta分析结果表明，相比于氨基己酸，氨甲环酸能有效减少患者围术期总失血量、术后引流量和血红蛋白丢失量，但在输血率、住院时间和深静脉血栓发生率方面并未显示出明显优势。氨甲环酸在关节置换过程中具有更好的止血疗效，因此，仍推荐氨甲环酸作为全髋、全膝关节置换过程中的首选止血药物。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 关节置换, 全膝关节置换, 全髋关节置换, 氨甲环酸, 氨基己酸, Meta分析

Abstract: OBJECTIVE: Tranexamic acid and epsilon-aminocaproic acid have been extensively utilized for hemostasis in orthopedic surgery; however, comparative studies focusing on the hemostatic efficacy of the two drugs in total joint arthroplasty remain relatively scarce. The present article was conducted to systematically assess the effectiveness and safety of two drugs in total hip arthroplasty and total knee arthroplasty. 
METHODS: Published studies on the perioperative application of tranexamic acid and epsilon-aminocaproic acid in total knee arthroplasty or total hip arthroplasty were identified from the following electronic databases: PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, VIP, and SinoMed from inception until November 1, 2024. After removing duplicate references, two researchers conducted literature screening and data extraction based on predefined inclusion and exclusion criteria. Statistical analysis of total blood loss, transfusion rate, incidence of deep venous thrombosis, and other relevant indicators was performed using Review Manager 5.3 software. 
RESULTS: This meta-analysis finally included 7 randomized controlled trials and 5 non-randomized controlled trials involving 4 101 patients. During total hip arthroplasty and total knee arthroplasty, compared with epsilon-aminocaproic acid, tranexamic acid could significantly reduce total blood loss (MD=−109.58, 95%CI: −169.08 to −50.07, P < 0.001), postoperative drainage volume (MD=−35.66, 95%CI: −64.99 to −6.33, P=0.02), and hemoglobin loss (MD=−0.25, 95%CI: −0.40 to −0.09, P=0.002), and the differences were significant. However, there were no significant differences in intraoperative blood loss, operation time, hospital stay, transfusion rate, blood transfusion unit per patient, and deep vein thrombosis incidence between the two groups (P > 0.05). 
CONCLUSION: Meta-analysis results show that compared with epsilon-aminocaproic acid, tranexamic acid can effectively reduce the perioperative total blood loss, postoperative drainage volume, and hemoglobin loss of patients, but it does not show obvious advantages in terms of blood transfusion rate, hospital stay, and deep vein thrombosis incidence. Tranexamic acid has better hemostatic effect during joint arthroplasty. Therefore, tranexamic acid is still recommended as the first choice hemostatic drug during total hip and total knee arthroplasties.  


Key words: joint arthroplasty, total knee arthroplasty, total hip arthroplasty, tranexamic acid, epsilon-aminocaproic acid, meta-analysis

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