目的：通过回顾既往公开发表的研究所提供的证据，对全髋关节置换术中使用氨甲环酸来减少出血量的有效性及安全性进行评估，同时对氨甲环酸的最佳剂量及给药方式进行探讨。方法：以"Tranexamic acid；Total hip arthroplasty；Blood loss；Method of administration；Venous thromboembolism"为检索词，对PubMed，Medline，Cochrane，Ovid，Science Direct数据库进行检索，纳入标准：1英文文献；2患者为成年患者；3文章主题为氨甲环酸在全髋关节置换术中的应用。排除标准：1关于其他关节置换手术的研究；2关于根治性矫形手术的研究。结果：（1）使用氨甲环酸可减少全髋关节置换术术后的出血；（2）通过与安慰剂组或对照组进行比较可以发现氨甲环酸组患者深静脉血栓形成的发病率低于安慰剂或对照组；（3）氨甲环酸的给药途径包括静脉给药（最常见），局部给药和口服给药（最少见）；（4）对于不同的给药途径，给药时间导致给药剂量也存在很大分歧。结论：氨甲环酸应用于全髋关节置换术，可以降低术中和术后失血量，尤其是术后失血量，进而降低临床输血量，降低因失血和输血导致的感染等并发症和副反应发生的风险。同时，氨甲环酸安全性良好，并不会额外增加静脉血栓栓塞发生的风险。但是，现有研究在给药途径和使用剂量等方面仍存在很大分歧，因此，未来的工作重点应集中于如何就氨甲环酸在全髋关节置换术中的使用时间、给药途径和使用剂量等方面进行优化，取得共识。

[1] CHAROENCHOLVANICH K,SIRIWATTANASAKUL P.Tranexamic acid reduces blood loss and blood transfusion after TKA:a prospective randomized controlled trial[J].Clin Orthop Relat Res,2011,469(10):2874-2880.
[2] VIJAY B S,BEDI V,MITRA S,et al.Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries[J].Saudi J Anaesth,2013,7(1):29-32.
[3] GANDHI R,EVANS H M,MAHOMED S R,et al.Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty:a meta-analysis[J].BMC Res Notes,2013,6(1):1-14.
[4] ALSHRYDA S,SUKEIK M,SARDA P,et al.A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement[J].Bone & amp; Joint Journal.2014,96-B(8):1005-1015.
[5] POERAN J,RASUL R,SUZUKI S,et al.Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States:retrospective analysis of effectiveness and safety[J].BMJ,2014,349:g4829.
[6] BENONI G,FREDIN H,KNEBEL R,et al.Blood conservation with tranexamic acid in total hip arthroplasty:A randomized,double-blind study in 40 primary operations[J].Acta Orthop Scand,2001,72(5):442-448.
[7] CLAEYS M A,VERMEERSCH N,HAENTJENS P.Reduction of blood loss with tranexamic acid in primary total hip replacement surgery[J].Acta Chir Belg,2007,107(4):397-401.
[8] CLAVE A,FAZILLEAU F,DUMSER D,et al.Efficacy of tranexamic acid on blood loss after primary cementless total hip replacement with rivaroxaban thromboprophylaxis:A case-control study in 70 patients[J].Orthop Traumatol Surg Res,2012,98(5):484-490.
[9] EKBÄCK G,AXELSSON K,RYTTBERG L,et al.Tranexamic acid reduces blood loss in total hip replacement surgery[J].Anesth Analg,2000,91(5):1124-1130.
[10] HOURLIER H,FENNEMA P.Single tranexamic acid dose to reduce perioperative morbidity in primary total hip replacement:a randomised clinical trial[J].Hip Int,2014,24(1):63-68.
[11] HUSTED H,BLØND L,SONNE-HOLM S,et al.Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplastyA prospective randomized double-blind study in 40 patients[J].Acta Orthop Scand,2003,74(6):665-669.
[12] HYNES M C,CALDER P,ROSENFELD P,et al.The use of tranexamic acid to reduce blood loss during total hip arthroplasty:an observational study[J].Ann R Coll Surg Engl.2005,87(2):99-101.
[13] IMAI N,DOHMAE Y,SUDA K,et al.Tranexamic acid for reduction of blood loss during total hip arthroplasty[J].J Arthroplasty,2012,27(10):1838-1843.
[14] JOHANSSON T,PETTERSSON L,LISANDER B.Tranexamic acid in total hip arthroplasty saves blood and money[J].Acta Orthopaedica,2005,76(3):314-319.
[15] KONIG G,HAMLIN B R,WATERS J H.Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty[J].J Arthroplasty,2013,28(9):1473-1476.
[16] LEE Q J,CHANG W Y E,WONG Y C.Blood-Sparing efficacy of oral tranexamic acid in primary total Hip arthroplasty[J].J Arthroplasty,2017,32(1):139-142.
[17] MARTIN J G,CASSATT K B,KINCAID-CINNAMON K A,et al.Topical administration of tranexamic acid in primary total hip and total knee arthroplasty[J].J Arthroplasty,2014,29(5):889-894.
[18] WANG C,KANG P,MA J,et al.Single-dose tranexamic acid for reducing bleeding and transfusions in total hip arthroplasty:A double-blind,randomized controlled trial of different doses[J].Thromb Res,2016,141:119-123.
[19] ZENG Y,SHEN B,YANG J,et al.Tranexamic acid administration in primary total hip arthroplasty:A randomized controlled trial of intravenous combined with topical versus single-dose intravenous administration[J].J Bone Joint Surg Am,2016,98(12):983-991.
[20] GILBODY J,DHOTAR H S,PERRUCCIO A V,et al.Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty[J].J Arthroplasty,2014,29(4):681-684.
[21] IRISSON E,HEMON Y,PAULY V,et al.Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery[J].Orthop Traumatol Surg Res,2012,98(5):477-483.
[22] PANCHMATIA J R,CHEGINI S,LOBBAN C,et al.The routine use of tranexamic acid in hip and knee replacements[J].Bull NYU Hosp Jt Dis,2012,70(4):246.
[23] RALLEY F E,BERTA D,BINNS V,et al.One intraoperative dose of tranexamic Acid for patients having primary hip or knee arthroplasty[J].Clin Orthop Relat Res,2010,468(7):1905-1911.
[24] WIND T C,BARFIELD W R,MOSKAL J T.The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty[J].J Arthroplasty,2014,29(2):387-389.
[25] SUKEIK M,ALSHRYDA S,HADDAD F S,et al.Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement[J].J Bone Joint Surg Br,2011,93(1):39-46.
[26] WEI Z,LIU M.The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty:a meta-analysis of 2720 cases[J].Transfus Med,2015,25(3):151-162.
[27] ZHOU X D,TAO L J,LI J,et al.Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials[J].Arch Orthop Trauma Surg,2013,133(7):1017-1027.
[28] DAHUJA A,DAHUJA G,JASWAL V,et al.A prospective study on role of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty and its effect on coagulation profile[J].The Journal of arthroplasty.2014,29(4):733-735.
[29] MCGRATH S,YATES P,PROSSER G.Oral tranexamic acid in hip and knee arthroplasty:A prospective cohort study[J].Open J Orthopedics,2014,4(8):215-220.
[30] KIM C,PARK SH,DAVEY J R.Tranexamic acid for the prevention and management of orthopedic surgical hemorrhage:current evidence[J].Hematol Res Rev,2015,6:239-244.