局部应用氨甲环酸复合镇痛鸡尾酒减少全膝关节置换术后出血的作用

Role of topical tranexamic acid plus cocktail analgesic in reducing blood loss during total knee arthroplasty

目的探讨全膝关节置换术（TKA）中局部应用氨甲环酸（TXA）复合镇痛鸡尾酒对减少术后失血的有效性及安全性。方法采用前瞻f=生病例对照研究分析2015年8月-2016年6月60例因膝关节损伤行初次TKA患者临床资料，其中男13例，女47例；年龄51～80岁，平均65．6岁。创伤性骨关节炎44例，退行性骨关节炎16例。按随机数字表法分为单用镇痛鸡尾酒组（A组，30例）和局部应用氨甲环酸复合镇痛鸡尾酒组（B组，30例）。A组于TKA术中置入假体前在膝关节内多点注射镇痛鸡尾酒，B组于TKA术中置入假体前在膝关节内多点注射氨甲环酸复合镇痛鸡尾酒。比较两组术中失血量、血红蛋白（Hb）、红细胞压积（Het）、术后引流量、术后总失血量、隐性失血量、输血率、纽约特种外科医院（HSS）膝关节评分、深静脉血栓（DVT）及其他并发症发生率。结果患者均获随访3个月。B组围术期Hb减少值[18．5（13．0，26．0）g／L]、Het减少值[5．6（4．1，7．8）％]均少于A组[23．0（21．0，35．5）g／L、7．2（6．1，10．7）％]（P〈0．05）。B组术后引流量[105．0（60．0，223．8）m1]、总失血量[596．0（426．1，795．3）m1]、隐性失血量[422．3（228．9，624．0）m1]均少于A组[162．5（118．8，245．0）ml、788．3（583．0，1082．4）ml、603．2（435．2，884．7）m1]（P〈0．05）。在术中失血量、输血率、HSS膝关节评分、DVT及其他并发症发生率方面，两组差异均无统计学意义（P〉0．05）。结论在TKA术中局部应用氨甲环酸复合镇痛鸡尾酒可减少围术期失血量，且不增加DVT发生的风险。

Objective To investigate the effect and safety of topical tranexamic acid（TXA） plus cocktail analgesic for reducing blood loss during total knee arthroplasty （TKA）. Methods A prospective case control study was made on 60 patients scheduled to undergo TKA because of knee injuries between August 2015 to June 2016. There were 13 males and 47 females, with the mean age of 65.5 years （ range, 51- 80 years）. Traumatic arthritis occurred in 44 patients and degenerative arthritis in 16 patients. The patients were assigned to separate cocktail analgesic group （ Group A, n = 30 ） and topical TXA plus cocktail analgesic group（ Group B, n = 30）, according to the random number table. Patients in Group A received multiple-point intra-articular cocktail analgesic injection before implantation of the prosthesis in TKA. While patients in Group B received multiple-point intra-articular TXA plus cocktail analgesic injection before implantation of the prosthesis. Between-group differences were compared with respect to intraoperative blood loss, hemoglobin change （Hb）, hacmatocrit （Hct）, postoperative drainage, total blood loss, hidden blood loss, blood transfusion rate, Hospital for Special Surgery （HSS） score, incidence of deep venous thrombosis （I）VT） and other complications. Results All patients were followed up for 3 months. Perioperative Hb reduction in Group B was 18.5 （ 13.0, 26.0） g/L, less than 23.0 （ 21.0, 35.5 ） g/L in Group A （P〈0.05）. Hct was reduced by 5.6（4.1, 7.8）% in Group B, while 7.2（6. l, 10.7）% in Group A （ P 〈 0. 05）. Postoperative drainage volume, total blood loss and occult blood loss in Group B were 105.0（60.0, 223.8） ml, 596.0 （426. 1, 795.3 ） ml, 422.3 （ 228.9, 624.0） ml respectively, decreased compared to Group A [ 162.5 （118.8,245.0） ml, 788.3 （ 583.0,1 082.4 ） ml, 603.2 （435.2, 884.7 ）ml respectively] （P 〈0. 05）. There were no significant differences in intraoperative blood loss, blood transfusion rate, HSS score and DVT incidence between the two groups （P 〉0. 05）. Conclusion Topical TXA plus cocktail analgesic can reduce blood loss during perioperative period in TKA, without increasing the risk of DVT.