关节内氨甲环酸灌注联合静脉滴注减少全膝关节置换术后出血的护理

Nursing of intra-articular tranexamic acid perfusion combined with intravenous in- fusion to reduce the postoperative bleeding after the total knee arthroplasty

目的研究关节内氨甲环酸灌注联合静脉滴注减少全膝关节置换术后出血的护理效果。方法选取我院2015年1月至2016年1月收治的全膝关节置换术患者90例为研究对象，按随机数字表法将其分为治疗组和对照组各45例。滴注方法：止血带打气前10rain，治疗组患者静脉滴注2．0g氨甲环酸溶于生理盐水100ml，对照组仅滴注生理盐水100ml。关节内灌注方法：止血带压力放掉前2min，治疗组通过引流管关节腔内灌注2．0g氨甲环酸溶于生理盐水100ml，对照组仅关节腔内灌注生理盐水100ml，并进行对症护理。对比两组患者的术后失血量、凝血功能及不良反应。结果术后24h治疗组失血量显著少于对照组，而术后48h及72h引流量两组比较，差异均无统计学意义（P〉0.05）。术后，治疗组及对照组术后引流量分别为（251．75±44．02）ml和（552．67±51．36）ml，隐性失血量分别为（601．58±60．12）ml和（894．69±117．40）ml，两组比较，差异均有统计学意义（P〈0.05）；两组患者凝血酶原时间、部分活化凝血酶原时间及国际标准化比值比较，差异均无统计学意义（P〉0.05）。两组均无感染及肺栓塞情况出现，患者无1例死亡。治疗组出现2例深静脉血栓，对照组出现3例，两组比较，差异均无统计学意义（P〉0.05）。术后，患者关节活动良好，均顺利出院。结论关节内氨甲环酸灌注联合静脉滴注在不影响凝血功能的情况下，可显著减少术后失血量，降低输血率，术后深静脉血栓发生率与对照组比较，差异无统计学意义，为安全、有效的治疗护理方法。

Objective To investigate the nursing of intra-articular tranexamic acid perfusion combined with intravenous infusion of to reduce the postoperative bleeding after the total knee arthroplasty. Methods A total of 90 cases of total knee arthroplasty in our hospital from January 2015 to January 2016 were selected as the study subjects. The patients were randomly divided into treatment group and control group according to the random number table method, 45 cases in each group. Instillation method ： 10 minutes before the tourniquet inflation, patients of the treatment group were treated with 100 ml of physiological saline of intravenous drop injection 2. 0 g ammonia tranexamic acid, while the con- trol group only drop 100 ml of physiological, saline. Intra articular injection methods： 2 minutes before the releasing of the tourniquet pressure, the treatment group was treated with 100 ml of joint cavity perfusion 2. 0 g tranexamic acid by th drainage tube, while the control group was only given 100ml of the intra-artieular infusion of physiological saline. And symptomatic care was implemented. The blood loss, blood coagulation function and adverse reactions were compared between the two groups. Results 24 hours after operation, the blood loss of the treatment group was significantly less than that of the control group, and there was no significant difference between the two groups 48 hours and 72 hours after operation （P〉0. 05 ） . After operation, the volume of drainage of the treatment group and control group were respectively （251.75±44. 02） ml and （552. 67±51.36） ml, the hidden blood loss volume was respectively （601.58±60. 12） ml and （894, 69±117.40） ml, and there were differences between the two groups （P〈0. 05） . There was no significant differences between the two groups in terms of the prothrombin time, partial activated prothrombin time and international normalized ratio （P 〉 0. 05 ） . No infection and puhnonary embolism were found in the two groups, and no death occurred. There were 2 cases of deep vein thrombosis in the treatment group and 3 cases in the control group, and there was no significant difference between the two groups （P〉0. 05） . After operation, the patients showed good joint activity and were all discharged from hospital. Conclusions Intra articular tranexamic acid perfusion combined with intravenous injection can significantly reduce postoperative blood loss, decrease the rate of blood transfusion without affecting coagulation function and there was no statistical significance in terms of the differences of the occurance rate of postoperative deep vein thrombosis compared with the control group, which is a safe and effective method for treatment and nursing.