全膝关节置换围术期脉冲冲洗联合氨甲环酸的应用

Application of perioperative pulse irrigation combined with tranexamic acid in total knee arthroplasty

背景:全膝关节置换围术期失血会影响患者的快速康复,诸多研究已证明氨甲环酸可减少围术期失血量,但也存在争议,尚无统一的观点。目的:探讨术中脉冲冲洗联合局部使用氨甲环酸对全膝关节置换围术期失血、炎症反应及并发症的影响。方法:选择2018年8月至2019年12月南京医科大学附属淮安第一医院收治的单侧膝关节骨性关节炎患者63例,其中男19例,女44例,年龄60-75岁,按照信封抽签法随机分2组:试验组32例接受全膝关节置换治疗,术中采用脉冲冲洗联合氨甲环酸局部应用来止血;对照组31例接受全膝关节置换治疗,术中采用常规冲洗联合氨甲环酸局部应用来止血。术后计算患者围术期总失血量及隐性失血量,记录输血患者数和输血量;术后1,7 d时进行血清炎性因子与凝血功能检测;术后7 d时行下肢血管彩超检查是否有深静脉血栓形成。研究方案经南京医科大学附属淮安第一医院伦理委员会批准。结果与结论:①试验组围术期总失血量、隐性失血量及输血率均低于对照组(P <0.05);②试验组术后1,7 d的C-反应蛋白、肿瘤坏死因子α及白细胞介素6水平均低于对照组(P <0.05);③两组凝血酶原时间、活化部分凝血活酶时间及国际标准化比值比较差异均无显著性意义(P> 0.05);④两组均无深静脉血栓形成;⑤结果表明与常规冲洗联合氨甲环酸局部使用组相比,术中脉冲冲洗联合局部应用氨甲环酸可显著降低全膝关节置换围术期总失血量及隐性失血量,降低输血率,减轻膝关节置换后的炎症反应。

BACKGROUND:Perioperative blood loss in total knee arthroplasty can affect the quick recovery of patients.Many studies have proved that tranexamic acid can reduce perioperative blood loss in total knee arthroplasty,but there is still controversy and no unified view.OBJECTIVE:To investigate the effect of pulse irrigation combined with topical use of tranexamic acid on perioperative blood loss,inflammatory response and complications in total knee arthroplasty.METHODS:Totally 63 patients with unilateral knee osteoarthritis including 19 males and 44 females,aged 60 to 75 years,who were treated in the Huaian First Hospital Affiliated to Nanjing Medical University from August 2018 to December 2019,were selected.The patients were randomly divided into two groups according to the envelope balloting method.In the experimental group,32 patients received intraoperative pulse irrigation combined with topical use of tranexamic acid in the total knee arthroplasty.In the control group,31 patients received conventional irrigation combined with topical use of tranexamic acid in the total knee arthroplasty.Total perioperative blood loss and hidden blood loss were calculated,and the number of transfusions and blood transfusion volume were recorded.Serum inflammatory factors and coagulation function were detected 1 and 7 days postoperatively.Color ultrasonography was performed to check deep venous thrombosis in the lower extremities on day 7 after surgery.The research plan was approved by the Ethics Committee of Huaian First Hospital Affiliated to Nanjing Medical University.RESULTS AND CONCLUSION:(1)Total perioperative blood loss,hidden blood loss and transfusion rate of the experimental group were lower than those of the control group(P<0.05).(2)At 1 and 7 days after the operation,c-reactive protein,tumor necrosis factor-αand interleukin-6 in the experimental group were lower than those in the control group(P<0.05).(3)There was no significant difference in prothrombin time,activated partial thrombin time and international standardized ratio between the two groups(P>0.05).(4)There was no deep vein thrombosis in the two groups.(5)The results have shown that compared with conventional irrigation combined with topical use of tranexamic acid,pulse irrigation combined with topical use of tranexamic acid could significantly reduce total and hidden blood loss in the perioperative period of total knee arthroplasty,reduce the blood transfusion rate,and reduce the inflammatory response after knee arthroplasty.