局部注射联合静脉滴注氨甲环酸对人工全膝关节置换术失血量的影响

Effect of local injections combined intravenous drip tranexamic acid on blood loss in total knee arthroplasty

目的:探讨局部注射联合静脉滴注氨甲环酸对人工全膝关节置换术失血量的影响。方法:对西安市红会医院关节外科2012年9月至2014年9月100例初次单侧全膝关节置换的患者资料进行分析,其中男性39例,女性61例。100例患者被随机分为4组,A组对照组25例;B组静脉滴注组25例;C组局部注射组25例;D组局部注射联合静脉滴注组25例;记录术后24 h伤口引流量、术后输血量、术后12 h血红蛋白减少量、隐性失血量,术后14 d彩色超声多普勒观察患者是否出现下肢深静脉血栓。结果:术后24 h伤口引流量、隐性失血量B、C、D组明显低于A组(P<0.05),其中D组最低。术后12 h血红蛋白保持水平B、C、D组明显高于A组(P<0.05),术后输血量D组明显低于A、B、C组(P<0.05),所有患者术后超声检查未发现下肢深静脉血栓。结论:氨甲环酸局部注射联合静脉滴注可以显著减少全膝关节置换术患者的失血量,联合应用并不增加血栓形成风险。

Objective： The purpose of this study was to evaluate the effect of local injections combined intravenous drip TXA on blood loss during TKA and the safety. Methods： From September 2012 to September 2014,clinical 100 patients undergoing cemented TKAs were analyzed retrospectively,including 39 male and 61 female patients. Consecutive patients were divided into four groups,as follows： A group（ control group,n = 25）,B group（ intravenous drip group,n = 25）,C group（ local injections group,n = 25）,and D group（ local injections combined intravenous drip group,n = 25）. We measured the volume of drained blood at 24 hours postoperatively and hidden blood loss. Haemoglobin（ HGB） levels were measured at 12 hours postoperatively. The number of patients requiring blood transfusion were recorded and compared. Deep-vein thrombosis（ DVT） were examined using the color Doppler ultrasonography at enrollment 14 days after operation. Results： The mean postoperative volumes of drained blood and hidden blood loss in B,C,D group were significantly lower than those in A group（ P〈0. 05）,and D group had the lowest values. Furthermore,B,C,D group could maintain the HGB level better than A group（ P〈0. 05）. The amount of blood transfusion in D group were significantly lower than those in A,B,C group（ P〈0. 05）. No DVT was found 14 days after operation. Conclusion： Local injections combined intravenous drip TXA reduced postoperative blood loss after TKA,and TXA was not associated with the risk of DVT.