关节内应用氨甲环酸对全膝关节置换术后失血量的影响

Effect of intra-articular tranexamic acid on postoperative blood loss in total knee arthroplasty

[目的]探讨关节腔内应用抗纤溶药物氨甲环酸对全膝关节置换术后失血量的影响。[方法]2012年6月-2012年12月,选取100例行初次单侧全膝关节置换术患者,男28例,女72例;年龄55-78岁,平均65.5岁;骨性关节炎76例,类风湿性关节炎24例,病程1-15年,平均6.5年。随机分为A、B两组,每组50例。A组在缝合关节囊后向关节腔内注射氨甲环酸1 g,溶于50 ml生理盐水;B组仅给予等量生理盐水关节腔内注射。记录术后失血量、输血量、输血例数、术后血红蛋白浓度和术后3 h纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间等为评价指标。观察患者是否出现下肢深静脉栓塞的临床症状,并于术后第7、14 d行下肢血管多普勒超声检查。[结果]A、B组术后可见失血量、输血量和输血例数比较差异有统计学意义（P〈0.05）;术后血红蛋白浓度,A组明显高于B组（P〈0.05）;两组患者术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间的比较差异无统计学意义（P〉0.05）。术后未发现下肢深静脉血栓形成。[结论]在全膝关节置换术中关节腔内应用氨甲环酸能明显减少患者术后失血量,降低输血率和输血量,并且避免了静脉内应用可能带来的并发症。

[Objective]To investigate the effect of intra- articular tranexamic acid on postoperative blood loss in total knee arthroplasty（ TKA）.[Method]Between June 2012 and December 2012,100 patients（ 28 men and 72 women; mean age,65. 5years [range,55- 78 years]） underwent TKA in our institute. Of the 100 patients,76 had osteoarthritis and 24 had rheumatoid arthritis. The illness course ranged from 1 to 15 years（ mean,6. 5 years）. The patients were randomly divided into groups A and B,with 50 patients each. The patients in group A received 1 g of tranexamic acid with 50 ml of normal saline inside the knee joint after capsule closure,and the patients in group B received an equal volume of normal saline. The amounts of postoperative blood loss and blood transfusion,the number of patients needing blood transfusion,and the postoperative hemoglobin concentration in all the 100 patients were determined. Fibrinogen,prothrombin time,and activated partial thromboplastin time were also examined 3 hours after the operation. The patients were also observed for whether they had deep vein thrombosis. Both lower limbs of all the patients were examined using color Doppler ultrasonography 7 and 14 days after the operation.[Result]Significant differences in the amount of postoperative visible blood loss,blood transfusion,and the number of patients needing blood transfusion were observed between groups A and B（ P〈 0. 05）. The postoperative hemoglobin concentration was higher in group A than in group B（ P〉0. 05）. No significant differences in fibrinogen level,prothrombin time,and activated partial thromboplastin time were observed between the two groups（ P〈 0. 05）. No postoperative deep vein thrombosis was found. [Conclusion]The intra- articular application of tranexamic acid in TKA could significantly reduce the amounts of postoperative blood loss and blood transfusion without important additional adverse effects.