关节内注射氨甲环酸联合引流管夹闭6小时方案对初次单膝关节置换术患者围术期失血的有效性及安全性研究

Study on the effectiveness and safety of intra-articular injection of tranexamic acid combined with drainage clamping 6 hour program on patients with perioperative blood loss of primary total knee replacement

目的分析关节内注射氨甲环酸联合引流管夹闭6 h方案减少初次单膝关节置换术患者围术期失血的有效性及安全性。方法选取浙江省兰溪市人民医院收治的进行76例单侧首次全膝关节置换术患者为研究对象。对照组关节腔内注射氯化钠溶液,保持引流管开放状态。实验组患者进行关节内注射氨甲环酸联合引流管夹闭6 h治疗方案。比较分析实验组与对照组患者的总失血量及并发症等临床指标。结果实验组与对照组均未出现严重不良反应,发生率分别为5.26%与7.89%,差异无统计学意义。实验组患者总失血量为（526.78±229.09）mL,显著少于对照组总失血量为（879.03±246.80）mL,具有统计学差异（P〈0.05）。对照组术后引流量为（489.08±267.80）mL,实验组术后引流量为（287.90±245.78）mL,差异具有统计学意义（P〈0.05）。在术后第7天,实验组与对照组患者进行静脉彩色超声检查,均未发现静脉血栓。结论关节内注射氨甲环酸联合引流管夹闭6 h方案在减少初次单膝关节置换术患者中的应用,临床效果较为理想,能够显著降低失血量,安全性较高。

Objective To study the intra-articular injection of tranexamic acid combined with drainage effectiveness and safety of clamping 6 hour program of perioperative blood loss of primary total knee replacement patients.Methods 76 cases of unilateral total knee replacement in our hospital for the study.In the control group,Sodium Chloride Solution was injected into the joint cavity to keep the drainage tube open.The experimental group underwent intra-articular injection of tranexamic acid combined with drainage clamping 6 hour treatment.The total blood loss and complications of the experimental group and the control group were compared and analyzed.Results There were no serious adverse reactions in the experimental group and the control group,the incidence rate was 5.26% and 7.89% respectively,and there was no significant difference（P〈0.05）.The total blood loss in the experimental group was（526.78±229.09） mL,significantly less than that in the control group,and the total blood loss was（879.03±246.80） mL,with statistical difference（P〈0.05）.The postoperative blood loss in the control group was（489.08±267.80） mL,and the postoperative blood loss in the experimental group was（287.90±245.78） mL,the difference was statistically significant（P〈0.05）.On the 7 day after operation,the patients in the experimental group and the control group received venous color Doppler ultrasonography,but no venous thrombosis was found.Conclusion The intra-articular injection of tranexamic acid combined with drainage clamping 6 hour scheme in reducing the initial application of patients with single knee arthroplasty,the clinical effect is ideal,can significantly reduce blood loss,high safety,has clinical significance.