“鸡尾酒”联合氨甲环酸膝关节灌注应用于单侧膝关节置换术的疗效观察

Therapeutic effects of intra-articular tranexamic acid combined with "cocktail" therapy on unilateral total knee arthroplasty

目的观察"鸡尾酒"联合氨甲环酸膝关节灌注应用于单侧膝关节置换术的临床效果。方法选取我院2014年6月1日-2016年6月1日膝关节重度骨关节炎行单侧全膝关节置换术的病例120例,随机分成两组,实验组60例在进行膝关节置换术时采用"鸡尾酒"联合氨甲环酸进行膝关节灌注,对照组60例常规行膝关节置换术。两组一般资料差异无统计学意义(P>0.05)。观察两组手术时间,术中失血量,术中应用止血带时间,术后3 d血红蛋白Hb下降值,术后3 d实际失血量,大、小腿周径变化率,术后疼痛视觉模拟评分,术后美国特种外科医院评分。结果两组手术时间、术中失血量、术中止血带时间、大腿周径变化率、小腿周径变化率差异无统计学意义(P>0.05);实验组术后3 d血红蛋白Hb下降值、术后3 d实际失血量和术后1 d、2 d、3 d疼痛视觉模拟评分分别为(23.5±7.2)g/L、(949.3±154.9)ml、6.3±1.7、6.3±1.6、5.9±1.5,均低于对照组的(26.2±6.9)g/L、(1 078.1±201.8)ml、6.9±1.2、6.8±0.9、6.4±1.0,差异均有统计学意义(P<0.05);两组术后4 d、5 d、14 d疼痛视觉模拟评分及术后1个月、3个月美国特种外科医院评分差异均无统计学意义(P>0.05)。结论 "鸡尾酒"联合氨甲环酸膝关节灌注应用于膝关节置换术,具有降低失血量、缓解早期术后疼痛等优点,有利于患者的快速康复。

Objective To observe the clinical therapeutic effects of intraoperative intra-articular tranexamic acid combined with ＂cocktail＂ therapy on unilateral total knee arthroplasty.Methods Clinical data about 120 patients with terminal osteoarthritis of the knee underwent unilateral total knee arthroplasty in Chinese PLA General Hospital from June 1 in 2014 to June 1 in 2016 were collected.Patients were divided into two groups randomly：experimental group（n=60 knees） received intraoperative intra-articular tranexamic acid combined with ＂cocktail＂ therapy in unilateral total knee arthroplasty and control group（n=60 knees） received traditional unilateral total knee arthroplasty.The differences in baseline data between two groups were insignificant（P〉0.05）.The differences of perioperative data between two groups were analyzed, including operating time, intraoperative blood loss, tourniquet time, reduction of Hb at 3 d after operation, total blood loss at 3 d after operation, thigh perimeter change rate, crus perimeter change rate.VAS scores were tested at 1, 2, 3, 5, 14 d after operation.HSS scores were tested at 1, 3 months after surgery.Results The differences in operating time, intraoperative blood loss, tourniquet time, thigh perimeter change rate and crus perimeter change rate between two groups were statistically insignificant（P〉0.05）.In the observation group, reduction of Hb and total blood loss at 3 d after operation were（23.5±7.2） g/L and（949.3±154.9） ml, less than（26.2±6.9） g/L and（1078.1±201.8） ml of the control group, the differences were statistically significant（P〈0.05）.In the observation group, the VAS scores at 1, 2, 3 d after surgery were 6.3±1.7, 6.3±1.6 and 5.9±1.5, less than 6.9±1.2, 6.8±0.9 and 6.4±1.0 of the control group, the differences were statistically significant（P〈0.05）.The differences of VAS scores at 4, 5, 14 d after surgery between two groups were statistically insignificant（P〉0.05）.The differences of HSS scores at 1, 3 months after surgery between two groups were statistically insignificant（P〉0.05）.Conclusion Intraoperative intra-articular injection of tranexamic acid combined with ＂cocktail＂ therapy on unilateral total knee arthroplasty provides advantages in short-term pain relief and less blood loss in perioperative period.It is helpful for the early recovery of patients with unilateral total knee arthroplasty.