氨甲环酸静注联合关节腔“鸡尾酒”混合液灌注在膝关节置换术中的应用研究

Application study of tranexamic acid intravenously combined with"cocktail"mixture perfusion in knee joint replacement

目的研究氨甲环酸静注联合关节腔"鸡尾酒"混合液灌注在膝关节置换术中的应用价值,为临床上提高膝关节置换术效果提供依据。方法选取2016年6月~2018年9月96例在我院实施膝关节置换术的患者进行研究。根据单纯随机抽样法,分为观察组(n=48)和对照组(n=48)。观察分析两组患者在手术过程中的失血量、引流量、术后血红蛋白及血细胞比容的变化情况、膝关节疼痛视觉模拟评分(VAS)、美国特种外科医院评分(HSS)、患膝屈伸活动范围以及并发症情况。结果观察组患者术中总失血量、隐性失血量、总引流量以及术后3 d的Hb和Hct下降值均明显低于对照组,差异有统计学意义(P<0.05);观察组术后1 d、2 d、3 d膝关节VAS评分均明显低于对照组,差异有统计学意义(P<0.05);两组患者术后4 d、7 d、14 d膝关节VAS评分及术后4周、8周的HSS评分相比,差异均无统计学意义(P>0.05);观察组患者只在术后3 d患膝的屈伸活动范围明显优于对照组,差异有统计学意义(P<0.05),在其余时间点,两组患膝的屈伸活动范围比较,差异均无统计学意义(P>0.05);两组患者术后均未出现并发症。结论氨甲环酸静注联合关节腔"鸡尾酒"混合液灌注可有效减少患者行膝关节置换术后的失血量和引流量,明显减轻患者术后的早期疼痛感,而且未有不良反应及相关并发症出现,有利于促进患膝早期的功能康复,可在临床上大力推广应用。

Objective To study the application value of tranexamic acid intravenous injection combined with joint cavity"cocktail"perfusion in knee replacement surgery,and to provide a basis for clinically improving knee replacement surgery.Methods A total of 96 patients who underwent knee replacement surgery in our hospital from June 2016 to September 2018 were selected as study subjects.According to the simple random sampling method,they were divided into observation group(n=48)and control group(n=48).The blood loss,drainage volume,postoperative hemoglobin(Hb)and hematocrit(Hct)changes,knee pain visual analog scale(VAS),hospital for special surgery(HSS),knee flexion and extension motion range and complications were compared between the two groups.Results In the observation group,the total blood loss,concealed blood loss,total drainage volume,and Hb and Hct reduction values at 3 d after surgery were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The knee VAS scores at 1 d,2 d,and 3 d after surgery were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The knee VAS scores at 4 d,7 d,and 14 d after surgery,and the HSS score at4 week and 8 week after surgery in both groups were compared,and the differences were not statistically significant(P>0.05).The motion range of flexion and extension of the observation group was significantly better than that of the control group only at 3 d after surgery,and the difference was statistically significant(P<0.05).At the other time points,there was no significant difference in the flexion and extension motion range of the knees between the two groups(P>0.05).There were no complications in the two groups.Conclusion Intravenous tranexamic acid combined with"cocktail"perfusion in the joint cavity can effectively reduce blood loss and drainage after knee replacement,and significantly reduce the patient’s early pain after surgery.There are no adverse reactions and related complications.It is conducive to the early functional rehabilitation of the affected knee,and can be promoted and applied clinically.