局部用药与静脉注射氨甲环酸减少全膝关节置换术后失血的临床疗效比较

Comparison of efficacy of topical versus intravenous tranexamic acid in reducing blood loss after total knee arthroplasty

目的比较局部用药与静脉注射氨甲环酸减少全膝关节置换术后失血的效果。方法采用回顾性研究方法,选取2018年1月至2019年1月在首都医科大学附属北京友谊医院接受全膝关节置换术的患者224例,根据氨甲环酸用药途径不同将其分为两组:静脉注射组(n=116)和局部用药组(n=108)。比较两组患者手术前后血红蛋白水平、止血带使用时间、术中出血量、术后引流量、住院时间,以及术后深静脉或肺栓塞、急性肾损伤或心血管系统等并发症的发生情况。结果与术前血红蛋白水平(132.1±14.0 g/L vs.131.7±12.5 g/L)相比,两组患者术后血红蛋白水平(102.6±11.7 g/L vs.100.2±12.1 g/L)均明显降低,差异具有统计学意义(P<0.05)。两组患者止血带使用时间(61.3±10.5 min vs.63.6±9.8 min)、术中出血量(52.7±12.4 ml vs.54.5±11.8 ml)、术后引流量(546.6±332.8 ml vs.582.3±317.5 ml)、住院时间(6.1±1.3 d vs.6.4±1.6 d),以及术后深静脉或肺栓塞、急性肾损伤或心血管系统等并发症的发生情况比较,差异均无统计学意义(P>0.05)。结论对于膝关节置换患者局部应用氨甲环酸与静脉注射氨甲环酸在控制术中出血、减少术后引流量及降低输血率等方面无显著性差异,对于静脉注射氨甲环酸具有禁忌证的患者,局部应用氨甲环酸也能有效地减少术中出血量和术后引流量,是一种较安全有效的给药途径。

Objective To compare the effect of topical versus intravenous tranexamic acid on reducing blood loss after total knee arthroplasty.Methods 224 patients who underwent total knee arthroplasty in Beijing Friendship Hospital,Capital Medical University from January2018 to January 2019 were enrolled in this retrospectively study.Patients were divided into two groups according to the different administration routes of Tranexamic acid:intravenous injection group(n=116)and topical application group(n=108).Hemoglobin level,tourniquet use time,intraoperative blood loss,postoperative drainage volume,length of hospital stay,and postoperative complications of deep vein or pulmonary embolism,acute kidney injury and cardiovascular system diseases were compared between the two groups before and after surgery.Results The postoperative hemoglobin level of the two groups(102.6±11.7 g/L vs.100.2±12.1 g/L)were significantly decreased compared with the preoperative(132.1±14.0 g/L vs.131.7±12.5 g/L),the differences were statistically significant(P<0.05).There was no significant difference between the two groups in tourniquet use time(61.3±10.5 min vs.63.6±9.8 min),intraoperative blood loss(52.7±12.4 ml vs.54.5±11.8 ml),postoperative drainage volume(546.6±332.8 ml vs.582.3±317.5 ml),length of hospital stay(6.1±1.3 d vs.6.4±1.6 d),and incidence of postoperative complications such as postoperative deep vein or pulmonary embolism,acute kidney injury or cardiovascular system diseases(P>0.05).Conclusion For patients undergoing total knee arthroplasty,topical application and intravenous injection of tranexamic acid have similar effects on reducing intraoperative bleeding,postoperative drainage and blood transfusion rate.For patients with contraindications to intravenous injection of tranexamic acid,topical application of tranexamic acid can also also effectively reduce intraoperative blood loss and postoperative drainage,and it is a safe and effective way of tranexamic acid administration.