氨甲环酸在全膝关节置换术围手术期的抗炎效果研究

Anti-inflammatory effect of tranexamic acid in the perioperative period of total knee arthroplasty

目的探索氨甲环酸(TXA)在全膝关节置换术(TKA)围手术期的抗炎效果及安全性。方法采用前瞻性研究方法,选取2018年10月至2020年3月在安徽医科大学附属安庆医院因膝骨关节炎(OA)行初次单侧TKA的患者80例,按照是否接受TXA治疗分为两组,每组40例。观察组:在松开止血带前10 min给予TXA 1 g静脉滴注,术后24 h内每3小时给药1次。对照组同一时间给予0.9%氯化钠注射液100 mL。比较两组患者在术前、手术结束即刻、术后第1天、术后第2天及术后第3天静脉血中白细胞介素6(IL-6)、红细胞沉降率(ESR)和C反应蛋白(CRP)水平,检测两组凝血功能及下肢深静脉血栓形成情况,比较两组患者术后疼痛、恶心呕吐及肌力情况。结果两组患者的年龄、性别、体质量指数(BMI)及美国特种外科医院膝关节(HSS)评分差异均无统计学意义(均P>0.05);经过单因素ANOVA得出,两组在术后第1天、术后第2天及术后第3天的IL-6(t_(1)=9.364,t_(2)=11.027,t_(3)=11.068)、ESR(t_(1)=20.94,t_(2)=18.898,t_(3)=22.797)和CRP(t_(1)=14.079,t_(2)=12.099,t_(3)=23.416)差异均有统计学意义(均P<0.05);回归分析结果显示,使用TXA的患者术后ESR(β=0.217,P=0.038)、IL-6(β=0.143,P=0.025)、CRP(β=0.032,P=0.010)的最大变化量较对照组小(β>0,P<0.10),且术后第3天对应指标值也更低(β>0,P<0.10)。两组术前、术后凝血功能差异均无统计学意义(均P>0.05)。两组患者均未出现下肢深静脉血栓。观察组患者术后疼痛、恶心呕吐情况及肌力的恢复均优于对照组,差异均有统计学意义(均P<0.05)。结论在初次单侧TKA中,TXA可以有效降低围手术期炎性反应,有利于减轻患者术后不良反应,促进功能恢复,具有较好的临床应用价值。

Objective To investigate the anti-inflammatory effect and safety of tranexamic acid in the perioperative period of total knee arthroplasty.Methods Eighty patients who underwent primary unilateral total knee arthroplasty because of knee osteoarthritis in Anqing Hospital of Anhui Medical University from October 2018 to March 2020 were included in this study.They were divided into an observation group and a control group(n=40/group)according to whether they received tranexamic acid treatment.In the observation group,1 g tranexamic acid was intravenously administered at 10 minutes before releasing tourniquet and once every 3 hours starting at 24 hours after surgery.In the control group,100 mL 0.9%sodium chloride injection was identically administered.Before surgery,immediately after surgery,and 1,2 and 3 days after surgery,interleukin-6 level,erythrocyte sedimentation rate and C-reactive protein level in the venous blood were compared between the observation and control groups.Coagulation function and lower extremity deep venous thrombosis in the two groups were monitored.Postoperative pain,nausea,vomiting and muscle strength were compared between the two groups.Results There were no significant differences in age,gender,body mass index and Hospital for Special Surgery knee score between the two groups(all P>0.05).Univariate analysis of variance revealed that there were significant differences in interleukin-6 level(t_(1)=9.364,t_(2)=11.027,t_(3)=11.068),erythrocyte sedimentation rate(t_(1)=20.94,t_(2)=18.898,t_(3)=22.797)and C-reactive protein level(t_(1)=14.079,t_(2)=12.099,t_(3)=23.416)between the two groups at 1,2 and 3 days after surgery(all P<0.05).Regression analysis revealed that the maximum differences in erythrocyte sedimentation rate(β=0.217,P=0.038),interleukin-6(β=0.143,P=0.025)and C-reactive protein(β=0.032,P=0.010)between before and after total knee arthroplasty in the observation group were significantly lower compared with the control group(β>0,P<0.10).Moreover,the differences in erythrocyte sedimentation rate,interleukin-6 and C-reactive protein at 3 days after surgery were significantly lower compared with at the other time points studied.Before and after surgery,there was no significant difference in coagulation function between the two groups(both P>0.05).Lower extremity deep venous thrombosis occurred in neither groups.The recovery of postoperative pain,nausea,vomiting,and muscle strength in the observation group was significantly superior to that in the control group(all P<0.05).Conclusion Application of tranexamic acid in primary unilateral total knee arthroplasty can effectively attenuate perioperative inflammatory reaction,reduce postoperative adverse reactions and promote functional recovery,which deserves clinical application.