关节内注射氨甲环酸对全髋关节置换术患者术后失血产生的影响

The Effect of Intra-articular Injection of Tranexamic Acid on Postoperative Blood Loss in Patients Undergoing Total Hip Replacement

目的分析关节内注射氨甲环酸对全髋关节置换术患者术后失血的影响。方法选取2016年8月—2018年12月于该院行全髋关节置换术的82例患者,随机分为两组,每组41例,对照组患者在缝合前给予20 mL生理盐水创面局部给药,术后夹闭引流管1 h后开放,观察组术中缝合手术切口前,在关节腔内注射20 mL氨甲环酸,术后夹闭引流管1 h后开放。对比两组患者手术前后血红蛋白浓度变化情况、术后输血率、术后输血量、隐性失血量、总出血量、术后引流量以及并发症发生情况。结果观察组患者术后输血率为19.51%,明显低于对照组的80.49%,差异有统计学意义(χ^2=30.488,P<0.05);观察组术后输血量、隐性失血量、总出血量、术后引流量均少于对照组,差异有统计学意义(t=7.873、10.260、9.989、12.057,P<0.05);两组术后24 h血红蛋白浓度均有所降低,但观察组降低幅度更小,组间差异有统计学意义(P<0.05);两组围术期均未出现肺栓塞与下肢深静脉血栓形成。结论关节内注射氨甲环酸利于减少全髋关节置换术后出血量,不良反应少,患者恢复快。

Objective To analyze the effect of intra-articular injection of tranexamic acid on postoperative blood loss in patients undergoing total hip arthroplasty. Methods From August 2016 to December 2018, 82 patients who underwent total hip arthroplasty in the hospital were selected and randomly divided into two groups, 41 cases in each group. The control group was given 20 mL of normal saline before suturing. After administration, the drainage tube was clamped and opened for 1 hour after the operation. The observation group was injected with 20 mL tranexamic acid into the joint cavity before the surgical incision was closed during the operation, and the drainage tube was clamped and opened for1 hour after the operation. The changes of hemoglobin concentration, postoperative blood transfusion rate, postoperative blood transfusion, hidden blood loss, total bleeding, postoperative drainage and complications were compared between the two groups of patients before and after surgery. Results The postoperative blood transfusion rate of the observation group was 19.51%, which was significantly lower than the control group’s 80.49%, the difference was statistically significant(χ^2=30.488, P<0.05);the volume of the observation group, hidden blood loss, total bleeding, and postoperative drainage were all lower than those of the control group, the differences were statistically significant(t=7.873, 10.260,9.989, 12.057, P <0.05);the hemoglobin concentration of both groups decreased at 24 h after surgery, but the observation group’s decreasing amplitude was smaller, and the difference between the groups was statistically significant(P<0.05);there was no pulmonary embolism and deep vein thrombosis of the lower extremities in the two groups during the perioperative period. Conclusion Intra-articular injection of tranexamic acid is beneficial to reduce blood loss after total hip arthroplasty, with less side effects and faster recovery of patients.