氨甲环酸使用方式对创伤性膝关节炎全膝关节置换患者失血量的影响

Effects of tranexamic acid with different methods on blood loss in traumatic knee arthritis patients with total knee arthroplasty

目的探讨氨甲环酸(tranexamic acid,TXA)使用方式对创伤性膝关节炎全膝关节置换(total knee arthroplasty,TKA)患者失血量的影响。方法选取霸州市第二医院2014年1月—2017年2月符合纳入标准的行单侧TKA手术治疗的创伤性膝关节炎患者128例,其中男性36例,女性92例;年龄56~81岁,平均68.2岁。按照数字列表法,分为对照组、静滴组、腔内注射组、局部冲洗组,每组32例。对照组不应用TXA治疗;静滴组为松止血带前15min给予TXA 0.5g稀释于100m L生理盐水中静滴;腔内注射组在关节囊缝合后通过引流管关节内注射TXA 0.5g;局部冲洗组为手术切口关闭时用TXA 0.5g稀释于250m L生理盐水中冲洗治疗。比较4组患者总失血量、显性失血量、隐性失血量,红细胞输注量及输注率。对手术后不良事件及并发症进行随访。结果 (1)不同组别患者在性别比、平均年龄、体质量指数、置换前血红蛋白、手术时间及止血带使用时间等方面比较均无统计学差异(P<0.05);(2)静滴组和腔内注射组总红细胞丢失量、显性失血量、隐性失血量、红细胞输注量及输注率均低于局部冲洗组和对照组(P<0.05)。腔内注射组显性失血量低于静滴组、局部冲洗组和对照组,静滴组隐性失血量低于腔内注射组、局部冲洗组和对照组;(3)手术后随访均无下肢深静脉血栓形成和肺栓塞发生。结论关节腔内注射TXA可有效减少术后的引流量,而静脉滴注可有效减少隐性失血,二者均能显著减少术后出血和输血。

Objective To explore the effects of tranexamic acid(TXA)with different methods on blood loss in traumatic knee arthritis patients with total knee arthroplasty(TKA).Methods Totally 128 cases of traumatic knee arthritis with unilateral TKA in the Second Hospital of Bazhou City from Jan.2014 to Feb.2017 were enrolled in this study.There were 36 males and 92 females,with an average age of 68.2 years(mean,56-81 years).According to the digital method,all patients were assigned randomly to control group,intravenous drip group,cavity injection group,and local flushing group,with 32 cases in each group.The patients in control group were not treated with TXA,the patients in intravenous drip group received 0.5g TXA(diluted in 100 mL NS)at 15 min before the tourniquet deflation,the patients in cavity injection group were injected with 0.5 g TXA through drainage tube after intraoperative suture of incision,and the patients in local flushing group were treated with flushing of 0.5 g TXA(diluted in 250 mL NS)when the incision closed.Total blood loss,dominant blood loss and hidden blood loss,amount of blood transfusion,blood transfusion rates in the four groups were compared.The postoperative adverse events and complications were followed up.Results (1)Gender ratio,average age,body mass index,hemoglobin before replacement,operation time and tourniquet using time in the four groups had no statistical difference(P>0.05).(2)Total blood loss,dominant blood loss,hidden blood loss,amount of blood transfusion,and blood transfusion rates in intravenous drip group and cavity injection group were less than those in local flushing group and control group(P<0.05).The dominant blood loss in cavity injection group was less than those in intravenous drip group,local flushing group and control group.The hidden blood loss in intravenous drip group was less than those in cavity injection group,local flushing group and control group.(3)Lower extremity deep vein thrombosis and pulmonary embolism did not happen after surgery.Conclusion Articular cavity injection of TXA can effectively reduce postoperative drainage,intravenous drip can effectively reduce hidden blood loss,and both can significantly reduce bleeding and postoperative blood transfusion.