氨甲环酸局部应用对单侧全膝关节置换术后隐性失血量的影响

The effect of local application of tranexamic acid in different concentration on hidden blood loss volume after unilateral total knee arthroplasty

目的探讨氨甲环酸局部关节腔内注射对减少全膝关节置换术后隐性失血量的作用。方法回顾性分析2011年2月至2013年5月因骨关节炎行全膝关节置换术的380例（380膝）患者的病例资料，男174例，女206例；年龄59-72岁，平均（63±4）岁。120例于术中紧密缝合关节囊后局部注射质量浓度30g／L的氨甲环酸生理盐水溶液50ml（1．5g氨甲环酸组），136例局部注射质量浓度10g／L的氨甲环酸生理盐水溶液50ml（0.5g氨甲环酸组），124例未应用氨甲环酸（无药物干预组）。于术后第1-3天连续测量患侧肢体周径，于术中和术后第1天测量术中失血量和术后引流量，监测三组患者的下肢静脉血栓形成及输血情况。结果全膝关节置换手术均顺利完成，围手术期未出现感染、坏死、脂肪液化等手术相关并发症，无腹泻、恶心及呕吐等氨甲环酸不良反应。三组病例手术时间、住院时间、麻醉方式、术后引流量、术中总失血量及术侧肢体周径变化的差异均无统计学意义（P〉0．05）。输血率：1.5g氨甲环酸组7．5％，0．5g氨甲环酸组13．2％，无药物干预组20．2％，差异有统计学意义；其中氨甲环酸用药组较无药物干预组降低，1.5g氨甲环酸组较0．5g氨甲环酸组更低（P〈0．05）。术后隐性失血量：1．5g氨甲环酸组（693．29±377．91）ml，0．5g氨甲环酸组（835．41±481．97）ml，无药物干预组（1032．75±322．19）ml，差异有统计学意义；其中氨甲环酸用药组较无药物干预组减小，1．5g氨甲环酸组较0．5g氨甲环酸组更小（P〈0．05）。结论全膝关节置换术中应用氨甲环酸关节腔内注射能减少术后隐性失血量，降低输血率，不增加下肢静脉血栓的风险。氨甲环酸局部应用对单侧全膝关节置换术后隐性失血量的作用成浓度依赖关系，1．5g氨甲环酸较0．5g氨甲环酸更有效。

Objective To evaluate the efficacy and safety of intra-articular injections of tranexamic acid （TXA） on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty （TKA）. Methods Primary TKA was performed on a total of 380 patients （380 knees） affected to various degrees by knee osteoarthritis. All the patients are divided into three groups according to different joint injection for 5 rain at the end of surgery in which： 120 patients received 1.5 g TXA injection,136 patients received 0.5 g TXA injection, 124 patients no pharmacological intervention （control group）. Blood loss, hidden blood loss, blood transfusion, drainage volume and limb circumference change after TKA were assessed. Results All the surgeries were well performed. No complication including infection, necrosis, and fat liquefaction has been observed. The results indicated no significant difference with pairwise comparisons in intra-operative time, intra-operative blood loss, hospitalization time, anes- thesia, and drainage volume and limb circumference change. The mean postoperative hidden blood loss （1.5 g TXA group 693.29± 377.91 ml, 0.5 g TXA group 835.41±481.97 ml, the control group 1 032.75±322.19 ml） and transfusion （1.5 g TXA group 7.5%, 0.5 g TXA group 13.2%, the control group 20.2%） requests were significantly different with pairwise comparisons among the three groups. Compared with the control group, both 1.5 g TXA group and 0.5 g TXA group showed better effects （P〈0.05）. Compared with the 0.5 g TXA group, 1.5 g TXA group showed better effects （P〈0.05）. Conclusion It can be concluded that intra-articular injection of TXA in patients undergoing unilateral TKA could significantly reduce postoperative hidden blood loss and blood transfusion, and did not increase the risk of phlebothrombosis. This efficacy demonstrated a concentration dependent effect. Compared with 0.5 g TXA, 1.5 g TXA performed a better efficacy.