静脉及关节腔内注射氨甲环酸减少全膝关节置换术后出血的对比研究

Comparison of effect of intravenous and intra-articular injection of Tranexamic Acid on reducing bleeding during total knee arthroplasty

目的比较全膝关节置换术中静脉给予氨甲环酸和关节腔内注射氨甲环酸减少出血及降低输血率的有效性。方法 80例因膝关节骨关节炎行全膝关节置换患者随机分为两组:静脉注射氨甲环酸组(1组)和关节腔注射氨甲环酸组(2组)。1组分别在术前、术中、术后静脉注射氨甲环酸3次。2组是在止血带放松前,将3 g氨甲环酸用生理盐水稀释成100 ml溶液,注入关节腔内。术后观察24和48 h的引流量及48 h内的总引流量,术后48 h血红蛋白量,同时监测输血及血栓情况。结果所有膝关节置换手术均顺利完成,无感染、坏死、脂肪液化发生。1组48 h的平均引流量是(409.5±185.8)ml,平均血红蛋白的下降值是(2.42±0.86)mg/dl,2组48 h的平均引流量是(386.5±89.1)ml,平均血红蛋白的下降值是(2.21±0.64)mg/dl。两组间的引流量和血红蛋白下降值比较,差异均无统计学意义(P>0.05)。其中1组有3例患者,2组有4例患者需要输血。术后14 d行双下肢彩色多普勒超声检查,均未发现有静脉血栓形成。结论对于减少全膝关节置换术术中出血,关节腔内注射氨甲环酸的作用等同于通过静脉给予3次氨甲环酸所起到的作用。

Objective To compare the effectiveness of intravenous and intra-articular regimens of Tranexamic Acid in reducing blood loss and transfusion requirement during the total knee arthroplasty. Methods Eighty consecutive patients, who planned to undergo total knee arthroplasty due to degenerative arthritis of knee joint, were randomly divided in two groups. The patients in group 1 received intravenous Tranexamic Acid while those in group2 received intra-articular Tranexamic Acid. The patients in the group 1 were totally given 3 intravenous injections before, during and after operation. For the patients in the group 2, 3 g of Tranexamic Acid diluted in 100 ml normal saline were injected intra-articularly before tourniquet release. Drainage volume was noted in 24 and 48 h after surgery and the total amount of fluid was recorded. Hemoglobin(Hb) was recorded 48 h after surgery, and blood transfusion and thromboembolic event were assessed. Results All the surgeries were well performed. No complication such as infection, necrosis or fat liquefection was observed. The mean Hb fall was(2.42 ± 0.86) mg/dl and the mean48-h drainage volume was(409.5 ± 185.8) ml in the group 1. The mean Hb decrease was(2.21 ± 0.64) mg/dl and the mean 48-h drainage volume was(386.5 ± 89.1) ml in the group 2. There was no significant difference in the mean Hb fall or the mean drainage volume between the two groups(P > 0.05). Three patients in the group 1 and 4 patients in the group 2 received blood transfusion(1 unit each), the difference was not significant between the two groups. Color Doppler ultrasonography of the lower extremities did not show any venous thrombus on the 14 th day after surgery. Conclusions Intra-articular injection of Tranexamic Acid has the same effect as three-dose intravenous regimen in reducing blood loss during total knee arthroplasty.