氨甲环酸不同给药途径对初次单侧人工全膝关节置换术后失血量及膝关节功能的影响

Effects of Different Administration Routes of Tranexamic Acid on Blood Loss and Knee Function After Primary Unilateral Total Knee Arthroplasty

目的探讨不同氨甲环酸给药途径对初次单侧人工全膝关节置换术后失血量及膝关节功能的影响。方法选取医院2015年1月至2018年1月行初次单侧人工全膝关节置换术患者90例,随机分为A组、B组和C组,各30例。A组患者行氨甲环酸关节腔局部注射,B组患者行氨甲环酸静脉滴注,C组患者行氨甲环酸生理盐水冲洗。结果术后,A组和B组患者的显性失血量、隐性失血量、输血例数均低于C组,且A组低于B组,组间比较差异显著(P <0. 05); 3组患者的血红蛋白(Hb)、红细胞比容(HCT)均低于术前(P <0. 05),且A组高于B组,A组和B组均显著高于C组,组间比较差异显著(P <0. 05);术后1周,A组膝关节功能评分(HSS)和B组均显著高于C组,且A组高于B组,组间比较差异显著(P <0. 05); A组、B组、C组不良事件发生率比较无显著差异(13. 33%比10. 00%比6. 67%,P> 0. 05)。结论不同氨甲环酸给药途径对初次单侧人工全膝关节置换术后失血量及膝关节功能有显著影响,关节腔局部给药可降低术后失血量,提高膝关节功能,且不增加深静脉血栓等不良事件,治疗安全有效,值得临床推广。

Objective To investigate the effects of different administration routes of tranexamic acid on blood loss and knee function after primary unilateral total knee arthroplasty.Methods Totally 90 patients underwent primary total knee arthroplasty in our hospital from January 2015 to January 2018 were selected and randomly divided into group A,group B and group C,30 cases in each group.The patients in group A received local injection of tranexamic acid into articular cavity,the patients in group B received intravenous drip of tranexamic acid,and the patients in group C were rinsed by with tranexamic acid and saline.Results After operation,the dominant blood loss,the recessive blood loss and the number of blood transfusion in group A and group B were significantly lower than those in group C,and those in group A were significantly lower than those in group B(P<0.05).The levels of hemoglobin(Hb)and hematocrit(HCT)in the three groups were significantly lower than those before treatment(P<0.05),those in group A were higher than those in group B,those in group A and group B were significantly higher than those in group C,and there were significant differences among the three groups(P<0.05).One week after the operation,the scores of hospital for special surgery(HSS)in group A and B were significantly higher than the score in group C,and that in group A was significantly higher than that in group B(P<0.05).The incidence rates of adverse events in group A,group B and group C were not statistically significant(13.33%vs.10.00%vs.6.67%,P>0.05).Conclusion Different administration routes of tranexamic acid have significant effects on blood loss and knee function of patients after primary unilateral total knee arthroplasty.Local administration of tranexamic acid in articular cavity can reduce blood loss and improve knee function without increasing adverse events such as deep vein thrombosis.It is safe and effective for treatment and worthy of clinical promotion.