全膝关节置换术全身局部联合序贯应用氨甲环酸的有效性及安全性研究

Efficacy and safety of intravenous and intra-articular sequential application of tranexamic acid during total knee arthroplasty

目的:研究氨甲环酸(tranexmic acid,TXA)不同给药方式对全膝关节置换术(total knee arthroplasty,TKA)围手术期总失血量的影响。方法:将70例行单侧初次TKA的患者随机分为3组:局部应用TXA为A组(n=24);序贯联合使用TXA为B组(n=23)。关节腔内注射等量生理盐水为C组(n=23)。围手术期检测患者的总失血量、输血量、输血率、引流量、下肢周径、D二聚体、血栓弹力图。结果:A、B、C组围手术期平均总失血量分别为(541±210)、(456±216)、(731±179)ml;A、B、C组术后24 h平均引流量分别为(104±44)、(98±48)、(160±60)ml。总失血量及引流量方面C组与A、B组比较有统计学差异(P<0.05),A、B组之间没有统计学差异(P>0.05)。3组患者在输血量、输血率、下肢周径方面结果没有统计学差异(P>0.05)。A组患者中发生了1例下肢深静脉血栓,其余患者均没有下肢深静脉血栓(deep vein thrombosis,DVT)的发生(P>0.05)。结论:TXA序贯联合应用组的总失血量和引流量较局部应用组少,但在统计学上没有差异。两者在输血量、输血率、下肢周径方面结果没有统计学差异。2种用药方式均不会增加下肢深静脉血栓发生的风险。

Objective：To assess the impact of different administration methods of tranexamic acid on total blood loss volume following primary unilateral total knee arthroplasty. Methods：Totally 70 patients receiving unilateral total knee arthroplasty were randomly divided into 3 groups. Tranexamic acid was given intra-articularly at the end of the operation in group A（24 patients）and intravenously as well as intra-articularly in group B（23 patients）. Meanwhile,intra-articular injection of saline solution was performed in group C（23 patients）. Total blood loss volume,transfusion rate,drainage volume,lower limb diameter（thigh and calf girth）,D-dimer as well as thrombelastogram of 3 groups were measured and compared. Results：Total blood loss volumes were（541±210）,（456±216）ml and（731 ±179） ml for three groups,respectively. Drainage volumes were（104 ±44）,（98 ±48） ml and（160 ±60） ml for each group. Both total blood loss volume and drainage volume were significantly higher in group C than the other two groups（P〈0.05）,while no significant difference was demonstrated between group A and group B（P〉0.05）. For other parameters like transfusion rate,lower limb diameter and deep venous thrombosis rate,no difference was detected among those 3 groups（P〉0.05）. Conclusion：Sequential application of intra-articular and intravenous tranexamic acid could reduce,though not significantly,blood loss volume and drainage volume than intra-articular injection alone. No significant difference has been found in terms of transfusion rate,lower limb diameter,and deep venous thrombosis rate following two different application methods.