关节腔内加压灌注氨甲环酸与初次全膝关节置换后失血量的关系

Blood loss in primary total knee replacement with intra-articular injection of tranexamic acid and presurization

背景:氨甲环酸在全膝关节置换过程中的使用逐渐盛行,使用方法不一。目的:探讨关节腔内加压灌注氨甲环酸对初次全膝关节置换后失血量的影响及安全性。方法:选择拟行单侧全膝关节置换的患者56例,随机分为2组。试验组置换后关节腔内注射100 mL溶有2.0 g氨甲环酸的生理盐水,大棉垫加压包扎膝关节,夹闭引流管4 h后负压吸引;对照组置换后常规大棉垫包扎,夹闭引流管4 h后负压吸引。置换后48 h内拔除引流管;置换后3 d每天复查患者血常规,并记录引流量;置换后四至五天行患侧下肢静脉彩超检查,观察血栓发生率。结果与结论:(1)试验组的手术总失血量、置换后显性失血量、置换后隐性失血量明显少于对照组(P<0.05);(2)2组患者在置换后血栓发生率方面差异无显著性意义(P>0.05);(3)结果提示,关节腔内加压灌注氨甲环酸能显著减少初次膝关节置换后的失血量,同时不增加下肢静脉血栓的风险。

BACKGROUND：Tranexamic acid is extensively used in the primary total knee replacement, but there are many different methods. OBJECTIVE：To explore the efficacy and safety of the intra-articular injection of tranexamic acid with pressurization in reducing the blood loss of primary total knee replacement. METHODS：Total y 56 patients undergoing unilateral total knee arthroplasty were enrol ed and randomly divided into two groups. Patients were given the intra-articular injection of 100 mL of saline solution dissolving 2.0 g of tranexamic acid with large pad pressure bandaging the knee, and 4-hour drainage tube close, and then underwent negative pressure suction （experimental group）;differently, the controls were given the normal pad bandage group. The drainage tube was removed within 48 hours after replacement. The patient blood routine examination was performed at the 3rd day, and at the same time, the volume of drainage was recorded;and the color Doppler ultrasound in ipsilateral lower extremity veins was conducted to observe the incidence of thrombosis at 4-5 days. RESULTS AND CONCLUSION：（1） The total blood loss, postoperative dominant blood loss, and hidden blood loss in the experimental group were significantly less than those in the control group （P〈0.05）. （2） No significant difference was found in the incidence of postoperative thrombosis between two groups （P〉0.05）. （3） These results indicate that the intra-articular injection of tranexamic acid with pressurization can significantly reduce the postoperative blood loss in the primary total knee arthroplasty, without increasing the risk of deep vein thrombosis.