静脉与局部应用氨甲环酸在初次全膝关节置换中的比较

Efficacy of intravenous versus topical administration of tranexanmic acid in primary total knee arthroplasty

背景:全膝关节置换围术期失血是影响患者术后恢复的重要因素,有越来越多的研究证明氨甲环酸可以有效减少全膝关节置换术中失血。目的:对比静脉与局部应用氨甲环酸对初次全膝关节置换围手术期失血量的影响。方法:105例单侧膝关节骨性关节炎全膝关节置换患者被随机分为3组,静脉应用氨甲环酸组于切开皮肤前及缝合皮肤后经静脉滴1.0 g氨甲环酸;局部应用氨甲环酸组于缝合皮肤后经引流管向关节腔内注射2.0 g(溶于20 m L生理盐水)氨甲环酸,术后夹闭引流管4 h后打开;对照组不应用氨甲环酸。记录3组患者术中失血量、术后24,48 h血红蛋白水平、术后引流量、血栓发生率等。结果与结论:(1)静脉应用氨甲环酸组及局部应用氨甲环酸组的术中失血量及术后引流量均明显少于对照组,差异有显著性意义(P<0.05);静脉应用氨甲环酸可以更有效的减少患者术后血红蛋白下降水平,而局部应用氨甲环酸则可以更有效的减少术后引流量;而静脉应用氨甲环酸组的总失血量(术中失血量+术后引流量)低于局部应用氨甲环酸组,差异有显著性意义(P<0.05);(2)3组患者在术后均未发生下肢深静脉血栓;(3)结果证实,静脉与局部应用氨甲环酸在初次全膝关节置换中均能显著减少围手术期失血量,并不会增加术后血栓形成的风险。

BACKGROUND:Blood loss is a significant concern for patients undergoing total knee arthroplasty(TKA).Increasing evidence has shown that tranexamic acid is effective in decreasing perioperative blood loss in TKA.OBJECTIVE:To compare the efficacy of two methods of tranexanmic acid administration on the perioperative blood loss in primary TKA.METHODS:Totally 105 patients with unilateral knee osteoarthritis undergoing TKA were randomly allocated to three groups:1 g of tranexanmic acid was administered intravenously before and after wound closure(group A);2 g of tranexanmic acid in 20 mL of normal saline was injected into the articualr cavity through the drainage after wound closure and the tube was clamped for 4 hours(group B);no tranexanmic acid administration(group C).The intraoperative blood loss,hemoglobin level at postoperative 24 and 48 hours,postoperative drainage volume and incidence of deep venous thrombosis were recorded.RESULTS AND CONCLUSION:(1)The intraoperative blood loss and postoperative drainage volume in the groups A and B were significantly less than those in the group C(P<0.05);the postoperative hemoglobin level in the group A was higher than that in the group B;the postoperative drainage volume in the group B was less than that in the group A;the total blood loss in the group A was significantly less than that in the group B(P<0.05).(2)None patient appeared with lower limb deep venous thrombosis.(3)These findings indicate that intravenous and topical administration of tranexamic acid can significantly reduce the perioperative blood loss in primary TKA,and cannot increase the risk of thrombosis.