鸡尾酒疗法对初次全膝关节置换术后失血量的影响及安全性评价

Effect of cocktail drug injection on blood loss and safety evaluation after primary total knee arthroplasty

目的探讨鸡尾酒疗法关节囊周围局部注射对控制初次行全膝关节置换手术失血量的有效性及安全性。方法回顾性分析2015年6月~2016年10月在中国中医科学院广安门医院南区骨二科行全膝关节置换患者90例,根据治疗方案分为治疗组45例和对照组45例,治疗组采用鸡尾酒疗法膝关节囊周围局部注射,50 mL关节腔内灌注;对照组采用生理盐水关节腔内灌注。术中两组均采用骨蜡局部封堵止血,术后夹闭引流管3 h,术后24 h拔除引流管,分别记录术后引流量、隐性失血量、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),国际标准化比值(INR)、D-二聚体(D-dimer),观察患者下肢血栓发生例数。结果治疗组患者术后显性失血量、隐性失血量少于对照组,输血人数少于对照组,差异有高度统计学意义(P<0.01);两组化验PT、APTT、INR、D-dimer比较差异无统计学意义(P>0.05);两组血栓发生率差异无统计学意义(P>0.05)。结论鸡尾酒疗法能有效减少初次全膝关节置换围术期失血量,是一种行之有效、安全的治疗方法。

Objective To investigate the effectiveness and safety of cocktail drug injection on blood loss and safety evaluation of local injection after primary total knee arthroplasty（TKA）. Methods Ninety patients who received primary TKA from June 2015 to October 2016 in Guang′anmen Hospital South district of China Academy of Chinese Medicine Sciences was retrospectively analysed and divided into treatment group and control group, with 45 cases in each group.Treatment group was treated with cocktail drug injection around knee joint capsule and 50 m L intra-articular injection,the control group were treated with saline intra-articular infusion. The bone wax was used to stop the bleeding in the two groups, and the drainage tube was clamped for 3 hours and removed 24 hours after the operation. Postoperative drainage, occult blood loss, prothrombin time（PT）, activated partial thromboplastin time（APTT）, international normalized ration（INR）, D-dimer value and deep venous thrombosis cases were recorded in both group. Results The dominant blood loss and hidden hemorrhage in the treatment group were less than the control group, the number of blood transfusion was less than the control group, the differences were highly statistically significant（P 〈 0.01）. Both groups had no statistically significant in PT, APTT, INR, D-dimer value（P 〉 0.05）. The incidence of thrombosis was no statistically significant between the two groups（P 〉0.05）. Conclusion The cocktail drug injection thearapy is an effective and safe method to control the amount of blood loss during the operation of primary TKA.