氨甲环酸联合术后引流管临时夹闭降低单侧全膝置换术后失血量的研究

Effects of tranexamic acid combined with temporary drain clamping on postoperative blood loss in total knee arthroplasty

目的 :探讨全膝置换术后氨甲环酸关节腔注射联合不同时限引流管夹闭的有效性和安全性。方法 :2012年1月至2013年12月,选择行初次单侧全膝关节置换患者160例,分为A组(生理盐水关节腔注射联合引流管夹闭2 h)、B组(氨甲环酸关节腔注射联合引流管夹闭2 h)、C组(生理盐水关节腔注射联合引流管夹闭4 h)和D组(氨甲环酸关节腔注射联合引流管夹闭4 h)4组。记录血红蛋白含量、引流量、隐性失血量、总血红蛋白丢失量、输血量、输血率、深静脉血栓发生率、皮下瘀斑面积,并对4组进行比较。结果:160例患者无切口感染、严重低氧血症以及有症状的肺栓塞等情况出现。术后1 d各组血红蛋白含量的差异有统计学意义(F=12.26,P=0.000),术后7 d各组血红蛋白含量的差异有统计学意义(F=20.74,P=0.000);术后各组引流量差异有统计学意义(F=38.71,P=0.000);术后各组隐性红细胞丢失量的差异有统计学意义(F=83.41,P=0.000);术后各组总红细胞丢失量的差异有统计学意义(F=102.68,P=0.000)。术后7 d多普勒彩色超声检查发现总的下肢静脉血栓栓塞发生率为3%(5/160),而且各组间差异无统计学意义(P=0.892),同时术后皮下瘀斑面积﹥1%发生率,各组间差异无统计学意义(P=0.143)。结论:氨甲环酸关节腔注射联合引流管夹闭4 h的方法,在全膝关节置换中操作简单,经济、有效,并发症较少。

Objective：To evaluate the efficacy and safety of one dose tranexamic acid combined with temporary drain lamping in primary unilateral total knee arthroplasty.Methods：Total 160 patients undergoing unilateral primary total knee arthroplasty between January 2012 and December 2013 were randomly divided into four groups（40 cases in each group）：group A（the drain was clamped for 2 hours after the operation and the patients received 20 ml physiological saline）,group B（the drain was clamped for 2 hours after the operation and the patients received 10 ml tranexamic acid and 10 ml physiological saline）,group C（the drain was clamped for 4 hours after the operation and the patients received 20 ml physiological saline）and group D（the drain was clamped for 4 hours after the operation and the patients received 10 ml tranexamic acid and 10 ml physiological saline）.The postoperative hemoglobin level,maximum hemoglobin loss,wound drainage,blood loss,the volume of blood transfusion,the number of patients inquiring blood transfusion,venous thrombo embolism rate,and ecchymosis rate were recorded and compared among the four groups.Results：There was no incision infection,severe hypoxia,and symptomatic pulmonary embolism in these groups.There were significant differences in hemoglobin content one day after operation in each group（F=12.26,P=0.000）,in the hemoglobin content 7 days after operation in each group（F=20.74,P=0.000）,in postoperative drainage in each group（F=38.71,P=0.000）;in the amount of invisible red blood cell loss in each group（F=83.41,P=0.000）,and in total red blood cell loss in each group（F=102.68,P=0.000）.Color Doppler ultrasound examination found that the total incidence of VTE was 3%（5/160） and there were no significant differences in each group（P=0.892）.There were no significant differences in postoperative subcutaneous ecchymosis area〉1%incidence（P=0.143）.Conclusion：Topical tranexami acid treatment combined with temporary clamping of drain for 4 hours could reduce postoperative blood loss,blood transfusion,and ecchymosis rate without increasing the risk of thromboembolic event after total knee arthroplasty.