氨甲环酸应用方式对全膝关节置换患者术后失血量的影响

Influence of application method of tranexamic acid on the blood loss after total knee arthroplasty

目的探讨氨甲环酸应用方式对人工全膝关节置换术后失血量的影响,并进行安全性评估。方法选取2015年3月至2016年7月符合纳入标准需行单侧全膝关节置换术的78例,按照区组随机法,分为A组、B组、C组,A组在止血带解除前10 min给予氨甲环酸溶液100 ml静滴(氨甲环酸1 g)。B组在止血带释放前假体植入后,切口内予氨甲环酸溶液100 ml(氨甲环酸1 g)浸泡5 min。C组缝合关节囊后通过引流管注入关节腔氨甲环酸溶液100 ml(氨甲环酸1 g),临时夹闭引流管2 h。比较3组术中出血量、隐性失血量、总失血量、术后总引流量、术后血红蛋白水平、输血情况及不良反应发生情况。结果术中失血量:A组(134.88±12.12)ml、B组(131.19±11.02)ml、C组(132.85±10.21)ml,差异无统计学意义(P=0.49>0.05);术后总引流量:A组(252.27±57.42)ml、B组(208.14±38.62)ml、C组(158.5±20.70)ml,B组、C组低于A组(P=0.00<0.05);隐性失血量:A组(351.03±89.87)ml、B组(288.96±67.13)ml、C组(180.26±31.33)ml,B组、C组低于A组(P=0.00<0.05);总失血量:A组(550.65±87.91)ml、B组(458.12±77.30)ml、C组(366.89±70.69)ml,B组、C组低于A组(P=0.00<0.05)。术后12、24、48 h血红蛋白减少量平均值:A组(24.62±3.51)g/L、B组(21.84±2.81)g/L、C组(17.43±2.24)g/L,B组、C组低于A组(P=0.00<0.05);术后输血病例A组4例、B组5例、C组2例,输血量B、C组小于A组(P=0.02<0.05)。3组均无术后感染、肺栓塞及下肢深静脉血栓形成等并发症发生。结论在全膝关节置换术中氨甲环酸应用方式与术后失血量有明显的相关性,局部关节腔注射止血效果优于静脉输液、局部浸泡。

Objective To investigate the influence of application method of tranexamic acid（ TXA） on the blood loss after total knee arthroplasty, and to assess the safety. Methods We chose 78 cases in accordance with the inclusive criteria who were treated with unilateral total knee arthroplasty from March 2015 to July 2016. According to the block randomization method, the patients were divided into Group A, Group B and Group C. The patients of Group A were injected intravenously with 100 ml TXA solution（ TXA 1 g） at 10 minutes before the tourniquet was released. In Group B, before the tourniquet was released and after the prosthesis was implanted, the patients were injected with 100 ml TXA solution（ TXA 1 g） in the incision, which was soaked for 5 minutes. In Group C, intra-articular incision of 100 ml TXA solution（ TXA 1 g） was carried out through the drainage tube after the joint capsule was sutured, and the drainage tube was temporarily clamped for 2 hours. The intraoperative blood loss, hidden blood loss, total blood loss, postoperative total volume of drainage, postoperative hemoglobin level, blood transfusion and adverse reactions were compared among the 3 groups. Results Intraoperative blood loss： Group A（ 134.88 ± 12.12） ml, Group B（ 131.19 ± 11.02） ml and Group C（ 132.85 ± 10.21） ml. There were no statistically significant differences（ P = 0.49 0.05）. Postoperative total volume of drainage： Group A（ 252.27 ± 57.42） ml, Group B（ 208.14 ± 38.62） ml and Group C（ 158.5 ± 20.70） ml. The postoperative total volume of drainage in Group B and Group C was lower than that in Group A（ P = 0.00 0.05）. Hidden blood loss： Group A（ 351.03 ± 89.87） ml, Group B（ 288.96 ± 67.13） ml and Group C（ 180.26 ± 31.33） ml. The hidden blood loss in Group B and Group C was lower than that in Group A（ P = 0.00 0.05）. Total blood loss： Group A（ 550.65 ± 87.91） ml, Group B（ 458.12 ± 77.30） ml and Group C（ 366.89 ± 70.69） ml. The total blood loss in Group B and Group C was lower than that in Group A（ P = 0.000 0.05）. At 12, 24 and 48 hours after the operation, mean hemoglobin reduction： Group A（ 24.62 ± 3.51） g/L, Group B（ 21.84 ± 2.81） g/L and Group C（ 17.43 ± 2.24） g/L. The hemoglobin reduction in Group B and Group C was less than that in Group A（ P = 0.00 0.05）. In all the postoperative blood transfusion cases, there were 4 cases in Group A, 5 cases in Group B and 2 cases in Group C. The amount of blood transfusion in Group B and Group C was less than that in Group A（ P = 0.02 0.05）. There were no complications in the 3 groups such as postoperative infection, pulmonary embolism or deep venous thrombosis of the lower extremity. Conclusions There is an obvious correlation between the application method of TXA in total knee arthroplasty and postoperative blood loss. The hemostatic effect of local articular cavity injection is better than that of intravenous fluids and partial immersion.