氨甲环酸及引流管在全膝关节置换过程中的合理应用

Rational application of tranexamic acid and drainage tube in total knee arthroplasty

背景:全膝关节置换后失血量大是当前临床工作中面临的重要问题,氨甲环酸可采用多种给药方式减少术后失血,大多在术后放置引流管,而局部应用氨甲环酸术后不放置引流管的方式尚未有明确的评估。目的:观察局部应用氨甲环酸对全膝关节置换后失血量的影响,并探讨引流管的合理应用方式。方法:将90例单侧全膝关节置换患者随机分为3组,A组生理盐水50 mL关节腔注射,术后放置引流管,并夹闭4 h;B组氨甲环酸1.6 g溶于生理盐水50 mL后关节腔注射,术后放置引流管,并夹闭4 h;C组氨甲环酸1.6 g溶于生理盐水50 mL后关节腔注射,术后不放置引流管。记录置换术中出血量,置换后2 d内每天记录血红蛋白、引流量、输血量及输血例数,并计算总失血量与隐性失血量,统计置换后7 d下肢深静脉血栓形成例数。对3组所有患者进行定期随访。结果与结论:(1)3组患者置换前资料、置换术中出血量差异无显著性意义(P>0.05);(2)术后总失血量、输血例数,B、C组明显少于A组,差异有显著性意义(P<0.05),B、C组间差异无显著性意义(P>0.05);(3)B组引流量明显少于A组,差异有显著性意义(P<0.05);(4)3组间隐性失血量差异无显著性意义(P>0.05);(5)3组患者均无深静脉血栓形成;(6)结果提示,局部应用氨甲环酸能明显减少全膝关节置换后引流量和总失血量,降低输血率,但对减少隐性失血量效果不明显,且不增加术后深静脉血栓形成的概率;局部应用氨甲环酸术后可以不放置引流管,方法简单、安全、有效。

BACKGROUND： Currently, large amount of blood loss after total knee arthroplasty （TKA） is an issue of concern in clinic, and tranexamic acid administrated by various ways is used to reduce postoperative blood loss. Drainage tubes are commonly placed postoperatively; however, there are no confirmed assessments on the local application of tranexamic acid without drainage tube placement. OBJECTIVE： To observe the effects of topical application of tranexamic acid on the blood loss after TKA, and to explore the reasonable application method of drainage tube. METHODS： Ninety patients with unilateral TKA were randomly divided into three groups. The patients in group A received the intraarticular injection normal saline （50 mL）, drainage tube was placed postoperatively, and closed for 4 hours; group B： the mixture of 50 mL of normal saline and 1.6 g of tranexamic acid was injected into the articular cavity, drainage tube was placed and closed for 4 hours; group C： the mixture of 50 mL of normal saline and 1.6 g tranexamic acid was injected into the articular cavity without drainage tube placed. The intraoperative blood loss was recorded. In the first two days postoperatively, the hemoglobin, drainage volume, blood transfusion volume and the number of blood transfusion were recorded daily. The total blood loss and hidden blood loss were calculated. The number of deep vein thrombosis of the lower extremity was recorded at 7 days postoperatively. All patients were followed up. RESULTS AND CONCLUSION： （1） The baseline data and intraoperative blood loss showed no significant differences among groups （P 〉 0.05）. （2） The postoperative total blood loss and the number blood transfusion in the groups B and C were significantly less than those in the group A （P 〈 0.05）, while the differences between groups B and C had no significance （P 〉 0.05）. （3） The drainage volume in the group B was significantly less than that in the group A （P 〈 0.05）. （4） The hidden blood loss did not differ significantly among groups （P 〉 0.05）. （5） None of deep venous thrombosis was observed. （6） These results suggest that topical application of tranexamic acid after TKA can significantly reduce the drainage volume and total blood loss, and can decrease the rate of blood transfusion, but cannot significantly reduce the hidden blood loss, nor will it increase the incidence of deep venous thrombosis. With topical application of tranexamic acid, the drainage tubeplacement is not needed, so the method is simple, safe and effective.