氨甲环酸关节腔注射联合引流管夹闭3h在单侧全膝关节置换术中止血效果分析

Effect of topical tranexami acid combined with temporary clamping of drain on reducing blood loss in total knee arthroplasty

目的探讨局部应用氨甲环酸联合引流管夹闭3 h对单侧全膝关节置换术出血量的影响。方法 2012年6月至2014年6月,前瞻性选择100例患有骨性关节炎行初次全膝关节置换术(TKA)的患者,随机分为两组:实验组(n=51),关节置换完成后松止血带前自引流管向关节腔注入氨甲环酸10 m L(含1 000 mg)+0.9%氯化钠10 m L,注入后引流管夹闭3 h;对照组(n=49),同期关节腔注入0.9%氯化钠溶液20 m L,注射后引流管未夹闭。比较两组患者术后1、7、14 d血红蛋白含量、术后最大血红蛋白丢失量、引流量、隐性失血量、总失血量、输血量、输血率、术后1 d D-二聚体值、术后7 d下肢静脉血栓(VTE)发生率、皮下瘀斑面积>1%发生率。其中计量资料的比较采用两独立样本t检验,率的比较采用χ2检验。结果术后1、7、14 d血红蛋白平均含量实验组高于对照组,差异有统计学意义(P<0.05)。术后最大血红蛋白丢失量、引流量、隐性失血量实验组少于对照组,差异有统计学意义(P<0.05)。实验组、对照组患者总失血量分别为(712.6±260.5)m L、(1109.6±350.5)m L,两组比较差异有统计学意义(t=6.45,P<0.05)。实验组与对照组输血量分别为(27.0±49.2)m L、(232.0±119.3)m L,两组比较差异有统计学意义(t=11.30,P<0.05);实验组与对照组输血患者分别为5例和21例,输血率分别为9.8%和42.9%,两组比较差异有统计学意义(χ2=14.19,P<0.05)。两组术后1 d D二聚体含量均升高,实验组低于对照组,差异有统计学意义(t=2.65,P<0.05);术后7 d两组患者静脉多普勒超声检查发现VTE发生率比较差异无统计学意义(χ2=0.24,P>0.05),术后皮下瘀斑面积>1%的发生率实验组少于对照组,差异有统计学意义(χ2=4.67,P<0.05)。结论 TKA术中局部应用氨甲环酸联合引流管夹闭3 h可显著降低TKA术后失血量、输血率及皮下瘀斑面积>1%发生率,并未增加血栓形成风险,是安全有效的。

Objective To explore the effectiveness of topical tranexami acid combined with temporary clamping of drain on reducing blood loss in total knee arthroplasty（TKA）.Methods From June 2012 to June 2014, the prospective and randomized study was conducted in the institute.Total of 100 patients,who were diagnosed primary osteoarthritis to undergo a primary TKA,were randomized into study group and control group with 5 1 cases in study group and 49 cases in control group.In study group,the drain was clamped for 3 hours after the operation and the patient received 1 000 mg tranexami acid and 10 mL physiological saline through the drain tube at the end of the operation.In control group,the drain was not clamped after the operation and the patient received 20 mL physiological saline respectively.The postoperative hemoglobin level,maximum hemoglobin loss,wound drainage,blood loss ,the volume of blood transfusion,the number of patients inquiring blood transfusion,D-Dimer,venous thrombo embolism （VTE） rate,ecchymosis rate were recorded and compared between the two groups.Two sided independent t-test was used to compare all normally distriuted continuous variables,and the chi-square test was used for rate test. Results The hemoglobin concentration in study group was significantly higher than that in control group on day 1,7,14 after TKA（P〈0.05）.The maximum hemoglobin loss,total drainage,hidden blood loss and maximum hemoglobin loss in study group were significantly less than those in control group （P〈0.05）.The total blood loss in study group was significantly less than that in control group [（712.6 ±260.5）mL]vs （1109.6 ±350.5）mL（t=6.45,P〈0.05）.The volume of blood transfusion were （27.0 ±49.2）mL vs （232.0 ±119.3）mL （t=11.30,P〈0.05）.The patients needing blood transfusion in study group were significantly less than those in control group （5 cases vs 21 cases,χ2 =14.19,P 〈0.05 ）.The blood transfusion rate were 9.8% and 42.9%.D-dimer was higher in one day after TKA than preoperative ones in both group,and there was significant difference in D-dimer between the two groups（t=2.65,P〈0.05）.In the study,two thromboembolic event occurred in both two groups and there was no significant difference between the two groups（χ2 =0.24,P〉0.05 ）.The ecchymosis rate in study group was less than that in control group （χ2 =4.67,P 〈0.05 ）.Conclusions Topical tranexami acid combined with temporary clamping of drain 3 hours could reduce postoperative blood loss,blood transfusion,ecchymosis rate without increasing the risk of thromboembolic event after TKA.