氨甲环酸关节腔注射在全膝关节置换术后的止血效果分析

Hemostatic efficacy analysis on intra-articular administration of tranexamic acid following total knee arthroplasty

目的探讨手术开始时使用止血带的单侧全膝关节置换术(TKA)患者,关节腔内注射氨甲环酸(TA)的止血效果及其持续时间。方法在安徽医科大学第一附属医院关节与显微修复外科选取60例行单侧TKA的患者,随机分为两组。对照组30例,不使用TA;实验组30例,关节囊缝合后关节腔内注射TA 20 mg/kg。分别计算两组患者术中失血量,术后引流量,输血患者比例,术后6、24、48、72 h血红蛋白(HB)、血细胞比容(HCT)及深静脉血栓发生比例等,并应用成组设计t检验及方差分析进行相应对比分析。结果两组患者术前一般资料,如性别(x^2=0.071,P>0.05)、年龄(t=-1.687,P>0.05)、身体质量指数(BMI)(t=1.668,P>0.05)等差异均无统计学意义,具有可比性。实验组和对照组术中出血量无统计学差异(t=1.221,P>0.05);实验组24 h引流量明显低于对照组(t=-2.552,P<0.05);两组患者输血比例上的差异也具有统计学意义(x^2=4.286,P<0.05);住院期间及术后3个月的随访中,两组均未出现下肢深静脉血栓等并发症。术后6、24、48、72 h,实验组HB及HCT与对照组比较存在统计学差异(P<0.05);术后0~6 h、6~24 h,实验组HB及HCT下降值与对照组比较存在统计学差异(P<0.05);但术后24~48 h、48~72 h内两组HB及HCT下降值无统计学差异(P>0.05)。结论对于手术开始时即使用止血带的单侧TKA患者,TA关节腔内给药可有效减少术后失血量,且不增加血栓性并发症的发生机率;关节腔内使用TA止血有效持续时间约为24 h。

Objective To observe the hemostatic efficacy and duration of tranexamic acid intraarticular administration in the patients who receive unilateral total knee arthroplasty（ TKA） using tourniquet at the beginning of the operation. Methods Sixty patients who underwent primary unilateral TKA in the department of joint and reconstructive microsurgery of the First Affiliated Hospital of Anhui Medical University were divided into two groups（ 30 patients in each group） ： the patients in the control group did not receive tranexamic acid; the patients in the treatment group received 20 mg / kg of tranexamic acid intra-articularlly. The amounts of intraoperative blood loss,postoperative hemoglobin（ HB） and hematocrit（ HCT）,volume of drainage,the number of patients needing blood transfusion in postoperative 6 h,24 h,48 h,72 h,and the symptoms of deep venous thrombosis were compared by t test and chi-square analysis respectively. Results The preoperative general informations of the patients in both groups were not significantly different,such as sex（ x^2= 0. 071,P〈 0. 05）,age（ t =- 1. 687,P〈 0. 05）,and body mass index（ t = 1. 668,P〈 0. 05）. There was no significant difference in the intraoperative blood loss（ t = 1. 221,P〈 0. 05）. Postoperative volume of drainage was significantly lower than that in the control group（ t =- 2. 552,P〈 0. 05）. The statistical difference was also found in terms of percentage of transfusion between the two groups（ x-2= 4. 286,P〈 0. 05）. No deep venous thrombosis was observed through doppler ultrasound examination during the hospitalization and postoperative three months. The values of postoperative HB and HCT in 6 h,24 h,48 h,and 72 h of the treatment group were higher than those in the control group（ P〈 0. 05）. The reductions of HB and HCT during 0- 6 h and 6- 24 h in the treatment group were significantly lower than that in the control group（ P〈 0. 05）. But the reductions of HB and HCT during 24- 48 h and 48- 72 h in the treatment group were not significantly different from the control group（ P〈 0. 05）. Postoperative volume of drainage was also significantly lower than that in the control group（ t =- 2. 552,P〈 0. 05）. The statistical difference was also found in terms of percentage of transfusion between the two groups（ x-2= 4. 286,P〈 0. 05）. No deep venous thrombosis was observed by doppler ultrasound examination during the hospitalization and postoperative three months. Conclusions The intra-articular administration of tranexamic acid in unilateral TKA patients using tourniquet at the beginning of the operation could significantly reduce the amounts of postoperative blood loss,and will not increase the deep venous thrombosis and pulmonary embolism. Its effective duration for hemostasis is about 24 hours.