氨甲环酸预防膝关节损伤关节镜术后出血效果分析

Efficacy of tranexamic acid in prevention of postoperative bleeding after arthroscopy for knee joint injury

目的探讨氨甲环酸预防膝关节损伤关节镜术后出血的效果。方法选取2013年 2月至2015年9月在武汉市第三医院光谷院区诊治的膝关节损伤患者94例，采用随机数字表法分为氨甲环酸组（47例）与对照组（47例），所有患者均给予关节镜下手术治疗，术后对照组给予0.9%氯化钠注射液静脉滴注预防出血，氨甲环酸组给予氨甲环酸静脉滴注预防出血。观察比较2组术后输血量与术后引流量、术后14 d内并发症发生情况和膝关节活动度及美国膝关节协会评分。结果所有患者均顺利完成手术，无术中严重并发症发生，术后切口均一期愈合。氨甲环酸组的术后输血量与引流量均明显少于对照组［（258±78）ml比（403±56）ml，t=9.144，P＜0.05；（387±56）ml比（476±56）ml，t=4.587，P＜0.05］。氨甲环酸组术后14 d内感染、血管神经损伤、肺栓塞、深静脉血栓形成等并发症总发生率明显低于对照组［6.4%（3/47）比29.8%（14/47）］（P＜0.05）。氨甲环酸组术后14 d膝关节活动度和美国膝关节协会评分均明显高于对照组［（81±4）°比（72±4）°；（58±5）分比（46±5）分］（均P＜0.05），且2组均明显高于术前［氨甲环酸组：（68±7）°、（37±5）分；对照组：（67±6）°、（37±6）分］（均P＜0.05）。结论氨甲环酸可有效预防膝关节损伤关节镜术后出血，能减少输血量与引流量，同时减少术后并发症的发生，从而促进膝关节功能的改善。

ObjectiveTo investigate the effect of tranexamic acid on postoperative bleeding after arthroscopy for knee joint injury. MethodsA total of 94 patients with knee joint injury patients who had arthroscopic operation in Guanggu District of Wuhan Third Hospital from February 2013 to September 2015 were randomly divided into tranexamic acid group（47 patients） and control group（47 patients）. The control group had 0.9% sodium chloride and the tranexamic acid group had tranexamic acid intravenous drip infusion for preventing bleeding. Postoperative blood transfusion volume and drainage volume were recorded. Complications, motion range of knee joint and American Knee Society Knee Score（KSS） on 14 d after operation were analyzed. ResultsAll patients were operated successfully; no serious intraoperative complications occurred. Postoperative blood transfusion volume and drainage volume in tranexamic acid group were significantly less than those in control group[（258±78）ml vs （403±56）ml, （387±56）ml vs （476±56）ml]（P〈0.05）. Incidence of complications （infection, neurovascular injury, pulmonary embolism and deep venous thrombosis） on postoperative 14 d in tranexamic acid group were significantly lower than that in control group[6.4%（3/47） vs 29.8%（14/47）]（P〈0.05）. Motion range of knee joint and score of KSS in tranexamic acid group were significantly higher than those in control group[（81±4）° vs （72±4）°; （58±5）scores vs （46±5）scores]（P〈0.05）; motion range of knee joint and score of KSS after operation were significantly higher than those before operation in both groups[tranexamic acid group：（68±7）°,（37±5）scores; control group：（67±6）°, （37±6）scores]（P〈0.05）. ConclusionsTranexamic acid can reduce postoperative blood transfusion volume and drainage volume, reduce occurrence of complications and improve joint function in patients with arthroscopic knee injury operation.