全膝关节置换后静脉与局部应用氨甲环酸对失血量的影响

Effects of intravenous versus topical application of tranexamic acid on blood loss following total knee arthroplasty

背景:目前关于全膝关节置换过程中使用氨甲环酸减少出血的报道越来越多,但对于使用方式的选择仍存在争议。目的:通过术中关节腔周围组织局部注射和静脉注射两种不同的给药途径,探讨氨甲环酸对初次单侧全膝关节置换后失血量的影响。方法:根据随机对照原则设计,选取滕州市中心人民医院2013年10月至2014年12月收治拟行单侧全膝关节置换的患者90例,随机分为静脉组和局部组(n=45)。静脉组患者在全身麻醉诱导期接受静脉输注氨甲环酸(10 mg/kg最大剂量1.2 g);局部组于假体安装结束后,缝合关节囊前,在关节周围软组织注射氨甲环酸(2 g溶于50 m L生理盐水)。比较两组患者置换后引流量、置换后次日血红蛋白及红细胞压积、输血例数,同时观察是否有肺栓塞及下肢深静脉栓塞的临床症状出现,必要时行下肢血管多普勒超声检查。结果与结论:置换后引流量、置换后次日血红蛋白值及红细胞压积、输血人数及输血比率比较,两组差异无显著性意义(P>0.05)。两组患者置换后14 d均未发现下肢深静脉血栓形成。提示与静脉全身应用相比,全膝关节置换过程中关节周围局部应用氨甲环酸同样能达到有效减少置换后失血和输血的效果,并可避免静脉应用氨甲环酸可能带来的相关并发症。

BACKGROUND：Increasing reports have focused on the application of tranexamic acid to reduce bleeding during total knee arthroplasty, but its usage method remains controversial. OBJECTIVE：To explore the impact of topical articular application of tranexamic acid and intravenous application of tranexamic acid on blood loss during primary unilateral total knee arthroplasty. METHODS：According to randomized control ed principle, 90 patients who received unilateral total knee arthroplasty in the Tengzhou Central People’s Hospital from October 2013 to December 2014 were enrol ed in this study, and randomly assigned to intravenous injection group and topical injection group （n=45）. Patients in the intravenous injection group were given tranexamic acid by intravenous injection （10 mg/kg, maximum 1.2 g） during the induction of anaesthesia. Patients in the topical injection group were given intraarticularly tranexamic acid （2 g dissolved in 50 mL physiological saline） before articular capsule suture and after prosthesis fixation. Drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, and the number of blood transfusion population were compared between the two groups. Simultaneously, clinical symptoms of pulmonary embolism and deep vein thrombosis in the lower limb were observed. If necessary, lower extremity vascular Doppler ultrasound was conducted. RESULTS AND CONCLUSION：No significant differences in drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, the number of blood transfusion population, and the proportion of blood transfusion were detected between the two groups （P〉0.05）. No deep vein thrombosis was found in the lower limbs at 14 days after replacement in both groups. These findings confirm that compared with intravenous systemic application, periarticular topical application of tranexamic acid during total knee replacement could obtain identical effects on reducing blood loss and blood transfusion after surgery, and could avoid relevant complications of intravenous application of tranexamic acid.