氨甲环酸关节腔内注射对全膝关节置换术后隐性失血的影响

Influence of hidden blood loss of intra-articular injection of tranexamic acid for total knee arthroplasty

目的探讨氨甲环酸关节腔内注射对全膝关节置换术后隐性失血的影响。方法选取2012年6月-2014年12月在我院行单侧全膝关节置换术治疗的60例患者为研究对象。男性14例,女性46例,年龄58-77岁,平均66.7岁,病程6-15年,平均9.1年。手术及麻醉均由同一组医生完成。将符合条件的患者随机分为2组,试验组（氨甲环酸组）30例,切口缝合完毕后将氨甲环酸1 g稀释至50 m L生理盐水中,用注射器沿引流管注入关节腔内。对照组30例,直接将50 m L生理盐水沿引流管注入关节腔内。比较二组患者术后显性失血量、隐性失血量、异体输血人数、输血比率。结果术后试验组与对照组显性失血量分别为389m L（170-505m L）和628m L（225-874m L）,差异有统计学意义（P〈0.05）。术后试验组与对照组隐性失血量分别为514 m L（374-819 m L）和917 m L（542-1297 m L）,差异有统计学意义（P〈0.05）。两组术后凝血机制无显著性差异。术后试验组输血人数及输血比率明显小于对照组,差异有统计学意义（P〈0.05）。结论膝关节腔内应用氨甲环酸能够有效地降低全膝关节置换术后患者的显性失血量和隐性失血量,减少术后异体输血的可能性,局部使用方便,未发现不良反应。

Objective To evaluate the influence of hidden blood loss of intra-articular injection of tranexamic acid for total knee arthroplasty.Methods 60 patients were treated with unilateral total knee arthroplasty（TKA） in our hospital from Jun 2012 to Decr 2014,including 14 males and 46 females with an average of 66.7 years（rang,58 to 77）,the course of illness ranged from 6 to 15 years,an average of 9.1 years.It had been finished by the same doctors and operation.All patients were randomly divided into two groups：experimental group and control group with 30 patients each.The patients in experimental group received 1g of tranexamic acid dissolved in 50 m L of normal sanline were administered intra-articular injections after closed incision.The patients in control group received 50 m L of normal sanline were administered intra-articular injections after closed incision.The dominant blood loss,hidden blood loss,blood transfusion population and ratio of each group were compared.Results Dominant blood loss of patients from experimental group and control group were 389 m L（170 to 505 m L） and 628 m L（225 to 874 m L）,and the difference were significant（P〈0.05）,respectively.Hidden blood loss of patients from experimental group and control group were 514 m L（374 to819 m L） and 917 m L（542 to 1297 m L）,and the difference were significant（P〈0.05）,respectively.In both groups,the difference of blood clotting mechanism was＇ t found after operation（P〈0.05）.The transfusion population and ratio of patients from experimental group was lower than that of patients from control group,and the discrepancy was significant（P〈0.05）.Conclusion Intra-articular injection of tranexamic acid can largely control and decrease the dominant and hidden blood loss and blood transfusion after total knee arthroplasty,it＇s convenient to used,without increasing on risk of adverse reactions.