初次单侧骨水泥型全膝关节置换:氨甲环酸使用方式对失血量的影响

Primary unilateral cemented total knee arthroplasty: effect of tranexamic acid usage on blood loss

背景:目前有关氨甲环酸在全膝关节置换过程中减少出血的报道越来越多,但对于优先选用何种使用方式仍存在争议。目的:探讨氨甲环酸及其不同使用方式对初次单侧骨水泥型全膝关节置换围手术期失血量的影响。方法:选取滕州市中心人民医院关节运动医学二科2013年1月至2014年6月拟行单侧骨水泥型全膝关节置换的患者60例,均采用骨水泥型人工膝关节假体。按性别以分层随机分组法分成3组:A组(n=20):置换开始时予100 m L生理盐水静滴,缝皮后关节腔内注射生理盐水10 mL;B组(n=20):置换开始时将氨甲环酸按10 mg/kg稀释于100 mL生理盐水中静滴,缝皮后关节腔内注射生理盐水10 mL;C组(n=20):置换开始时予100 mL生理盐水静滴,缝皮后关节腔内注射氨甲环酸500 mg与10 m L生理盐水混合液。记录各组置换后显性失血量、隐性失血量、输血比率、输血量,同时观察是否有肺栓塞及下肢深静脉栓塞的临床症状,必要时行下肢血管多普勒超声检查。结果与结论:B组及C组患者显性失血量和隐性失血量均较A组明显减少,差异有显著性意义(P<0.05);B组与C组在显性失血量方面差异无显著性意义(P>0.05),在隐性失血量方面B组显著小于C组(P<0.05);B组及C组患者输血人数及输血比率明显小于A组,差异有显著性意义(P<0.05);3组患者置换后14 d均未发现下肢深静脉血栓形成。提示氨甲环酸能明显减少初次单侧人工骨水泥型全膝关节置换后的显性失血量、隐性失血量、输血比率及人均输血量,不增加下肢深静脉血栓形成的风险,且静脉用药更为有效。

BACKGROUND：Increasing evidence has focused on the application of tranexamic acid to reduce bleeding during total knee arthroplasty, but its usage method remains controversial. OBJECTIVE：To explore and discuss the effect of tranexamic acid and different usage methods on blood loss in the perioperative period of primary unilateral cemented total knee arthroplasty. METHODS：Sixty patients who were candidates for unilateral cemented total knee replacement in the Second Department of Joint Sports Medicine, Tengzhou Central People’s Hospital, from January 2013 to June 2014, were included in this study. Al patients were randomly divided into three groups. Group A （n=20）：patients were injected with 100 mL normal saline through intravenous drip when the operation began, and then with＆nbsp;10 mL normal saline through intra-articular injection after skin closure. Group B （n=20）：patients were injected with 10 mg/kg tranexamic acid which was dissolved in 100 mL normal saline when the operation began, and then with 10 mL normal saline through intra-articular injection after skin closure. Group C （n=20）：patients were injected with 100 mL normal saline when the operation began, and then with 500 mg tranexamic acid dissolved in 10 mL normal saline through intra-articular injection after skin closure. The dominant blood loss, hidden blood loss, blood transfusion ratio and per capita of each group were compared. Clinical symptoms of pulmonary embolism and lower limb deep vein thrombosis were observed. Doppler ultrasound examine on lower extremity would be performed if necessary. RESULTS AND CONCLUSION：Dominant and hidden blood loss of patients from groups B and C were significantly lower than that of patients from group A （P0.05）, the hidden blood loss in group B was significantly less than that in group C （P〈0.05）. The transfusion population and ratio of patients from groups B and C were significantly lower than that of patients from group A （P〈0.05）. In al three groups, no deep vein thrombosis was found at 14 days after operation. Tranexamic acid can largely reduce the dominant and hidden blood loss, as wel as blood transfusion ratio and per capita of each group after primary unilateral cemented total artificial knee arthroplasty, without increasing the risk of lower extremity deep vein thrombosis. The use of tranexamic acid injecting through intravenous drip is more effective than the use of intra-articular injection.