术中局部灌注氨甲环酸对减少全膝关节置换出血量的临床研究

Clinical study on the effect of intraoperative local instillation of methacylic acid on reducing blood loss during total knee arthroplasty

目的探讨术中局部灌注氨甲环酸对减少全膝关节置换出血量的效果。方法回顾性分析2017年3月至2018年3月首都医科大学大兴教学医院收治的120例行单侧全膝关节置换术患者,平均分为A、B两组,每组各60例。A组0. 5 g血栓素50 ml松止血带之前顺引流管打入关节腔内,闭管3 h; B组:0. 5 g,0. 9%氯化钠溶液松止血带之前顺引流管打入关节腔内,闭管3 h。观察两组患者术中失血量、输血情况以及凝血指标变化情况。结果在失血量、显性及隐性失血量方面,A组均显著低于B组(P <0. 05);在异体输血量(A组:253. 56±141. 62 ml,B组:427. 13±140. 45 ml)和输血例数(A组:8例; B组:17例)方面,A组均显著低于B组(P <0. 05);两组患者治疗后,凝血指标均有所变化,但A组患者改变更加显著,改变幅度明显高于对照组,差异具有统计学意义(P <0. 05);患者均未出现肺栓塞、下肢深静脉血栓等并发症,也未出现不愈合和愈合延迟等情况。结论应用氨甲环酸术中局部灌注能显著减少全膝关节置换术的出血量,减少临床用血,且安全性较高。

Objective To explore the effect of intraoperative local perfusion of tranexamic acid on reducing blood loss in total knee arthroplasty.Methods A total of 120 patients with unilateral total knee arthroplasty were treated in this hospital during March 2017 to March 2018.They were divided into 2 groups,60 cases in each group.Patients in group A were injected with 0.5 g thromboxane 50 ml into the articular cavity through drainage tube before loosening the tourniquet.The drainage tube was inserted into the articular cavity before 0.5 g thromboxane 50 ml loose tourniquet,and the drainage tube was inserted into the articular cavity for 3 h in group B before loosening the tourniquet with 0.9%sodium chloride solution of 0.5g% for 3 h.Blood loss,blood transfusion and coagulation indices were observed in both groups.Results The amount of blood loss in group A was significantly lower than that of group B(P<0.05),and the number of cases need blood transfusion in group A was significantly lower than that of group B(P<0.05),and the changes in coagulation indices in group A were more significant than those of group B(P<0.05),and the amplitude of change in group A was significantly higher than that of group B(P<0.05).But in group A,the changes were more significant,the extent of change was significantly higher than that of control group(P<0.05),and there was no complications such as pulmonary embolism,deep vein thrombosis in lower extremity,and non-union and delay in healing,etc.Conclusion The application of tranexamic acid can signicantly reduce the amount of blood loss and blood transfusion with high safety in total knee arthroplasty.