氨甲环酸联合引流管夹闭4h在双侧全膝关节置换术中的临床疗效分析

Efficacy of Tranexamic Acid Combined with Temporary Clamping of Drain for 4 Hours on Reducing Perioperative Bleeding during Simultaneous Bilateral Total Knee Arthroplasty

目的:探讨氨甲环酸联合引流管夹闭4 h减少同期双侧人工全膝关节置换术围手术期出血的有效性和安全性。方法:选择2015年3-8月北京积水潭医院同期行双侧人工全膝置换术患者40例,按照随机数字表法分为两组,试验组(n=25)上止血带前静滴氨甲环酸1 g(10 m L),手术结束后每侧关节腔内注射氨甲环酸2 g,并将引流管夹闭4 h;对照组(n=15)未使用氨甲环酸及未夹闭引流管,仅在术后关节腔注射20 m L生理盐水。记录两组术后引流量、总失血量、隐性出血量、输血率、输血量、血红蛋白水平、D-二聚体及静脉栓塞发生情况。结果:试验组与对照组术后总引流量分别为(188.6±101.2)m L和(809.9±223.6)m L,总失血量分别为(778.2±368.8)m L和(1582.2±452.4)m L,隐性失血量分别为(541.0±288.2)m L和(1023.6±567.8)m L,总输血量分别为(1.5±1.2)U和(5.8±2.2)U,输血率分别为52%(13/25)和100%(15/15),两组各指标比较差异均有统计学意义(P<0.05);试验组与对照组术后第7天血红蛋白水平分别为(98.8±22.2)g/d L和(89.6±16.6)g/d L,差异有统计学意义(P<0.05);两组术后1 d D-二聚体含量均升高,试验组低于对照组,差异有统计学意义(P<0.05);试验组与对照组术后7 d及术后3个月时静脉栓塞发生情况比较,差异均无统计学意义(P>0.05)。结论:静滴结合关节内注射氨甲环酸并夹闭引流管4 h可减少同期双侧人工全膝关节置换术后出血量,降低对输血的需求,且不增加血栓发生风险。

Objective： To investigate the safety and efficacy of Tranexamic Acid combined with temporary clamping of drain for 4 hours on reducing perioperative bleeding during simultaneous bilateral total knee arthroplasty （TKA） .Method： From March 2015 to August 2015, the prospective and randomized study was conducted in the institute.A total of 40 patients, who underwent simultaneous bilateral TKA, were randomized into the study group and （ n=25 ） the control group （ n=15 ） .In the study group, 1 g （ 10 mL ） Tranexamic Acid was injected into the vein before using a tourniquet, 2 g Tranexamic Acid was then given by intra-artieular injection after the surgery, and the drain was clamped for 4 hours after the operation.In the control group, the drain was not clamped after the operation and the patient received 20 mL physiological saline.Total blood loss, drain volume, hidden blood loss, transfusion volume, transfusion rate, hemoglobin, D-dimer and thrombotic events of two groups were recorded. Result：The total volume of drainage in the observation group and the control group were respectively（ 188.6 ± 101.2 ） mL and （ 809.9 ± 223.6 ） mL, total blood loss were respectively （ 778.2 ± 368.8 ） mL and （ 1582.2 ± 452.4 ） mL, hidden blood loss were respectively （ 541.0 ± 288.2 ） mL and （ 1023.6 ± 567.8 ） mL, total amount of blood transfusion were respectively （ 1.5 ± 1.2 ） U and （ 5.8 ± 2.2 ） U, blood transfusion rate were respectively 52% （ 13/25 ） and 100% （ 15/15 ）, there were statistical significance （ P〈0.05 ） .The hemoglobin level of two groups on the 7 day after the operation were respectively （ 98.8 ± 22.2 ） g/dL ± （ 89.6 ± 16.6 ） g/dL, there was statistical significance （ P〈0.05 ） .D-dimer was higher in one day after TKA than preoperative ones in both two groups, and there was significant difference in D-dimer between two groups （P〈0.05） .Thrombotic events were not visible in both two groups.Conclusion： The combination of intravenous and intra-articular injection of Tranexamic Acid combined with temporary clamping of drain for 4 hours could reduce postoperative blood loss, blood transfusion, without increasing the risk of thromboembolic event after simultaneous bilateral TKA.