氨甲环酸的不同应用方式在膝关节单髁置换术中失血量的比较

Effect of Different Tranexamic Acid Administration Methods on Lowering Blood Loss During Unicompartmental Knee Arthroplasty

目的比较关节腔注射(articular injection,AI)、静脉滴注(intravenous injection,II)联合关节腔注射(AI+II)应用氨甲环酸(tranexamic acid,TXA)以及未应用氨甲环酸对膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)患者失血量(blood loss,BL)以及相关并发症的影响。方法回顾性探究山西医科大学第二医院骨科2018年9月至2020年3月行UKA治疗内侧OA的患者120例,其中男35例,女85例;年龄51~88岁,平均(69.2±7.7)岁。按随机数字表法分为三组,AI组(40例)、AI+II组(40例)以及未曾应用TXA的空白对照组(40例)。分别比较三组患者术前血红蛋白(hemoglobin,Hb)浓度、术后Hb浓度、Hb下降程度、红细胞压积(hematocrit,Hct)与部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、D-二聚体(D-Dimer,D-Di)。结果AI组术后Hb浓度、Hb下降程度、术后Hct分别为(124.8±4.1)g/L、(11.2±3.6)g/L、(39.1±2.4)%,AI+II组分别为(126.0±3.8)g/L、(9.3±4.4)g/L、(39.1±2.2)%,对照组分别为(120.7±4.4)g/L、(15.5±6.1)g/L、(37.8±14.2)%,AI组与AI+II组比较,差异无统计学意义(P>0.05);AI组、AI+II组术后Hb浓度、Hct均高于对照组,且Hb下降程度均低于对照组,差异有统计学意义(P<0.05)。AI组术后APTT、PT、D-Di分别为(29.7±1.2)s、(12.7±0.8)s、(473.2±74.9)ng/mL,AI+II组分别为(28.6±1.5)s、(12.2±0.5)s、(603.0±148.7)ng/mL,对照组分别为(29.8±1.4)s、(12.9±0.8)s、(486.0±80.0)ng/mL,AI组与对照组比较,差异无统计学意义(P>0.05);AI组和对照组术后APTT、PT都高于AI+II组,且术后D-Di均低于AI+II组,差异有统计学意义(P<0.05)。结论在UKA术中,相比联合组应用TXA,AI组应用TXA在减少相同失血量的情况下,下肢深静脉血栓发生风险更低,且与对照组相似,更加安全。本研究认为在UKA术中单纯通过AI应用TXA,可以使患者在围术期拥有更少的失血量,且更加安全。

Objective To compare the effect of different Tranexamic acid(TXA)administration methods,namely,articular injection(AI),intravenous injection(II)combined with AI(AI+II),and no application of tranexamic acid on blood loss(BL),blood transfusion(BT),and related complications in patients undergoing unicompartmental knee arthroplasty(UKA).Methods A analysis was conducted on 120 patients,who suffered from unilateral medial compartment knee osteoarthritis and were treated with UKA from September 2018 to March 2020.There were 35 males and 85 females,aged from 51 to 88 years,with an average age of 69 years.They were divided into three groups according to the random number table method:single AI(n=40),AI+II(n=40),and control group(n=40).The preoperative and postoperative hemoglobin(Hb)concentrations,Hb decline degree,hematocrit(Hct)test,activated partial thromboplastin time(APTT),prothrombin time(PT),and D-dimer were compared among the three groups.Results The postoperative Hb concentration,decrease degree of Hb and postoperative HCT in AI group were(124.8±4.1)g/L,(11.2±3.6)g/L and(39.1±2.4)%respectively,those in AI+II group were(126.0±3.8)g/L,(9.3±4.4)g/L and(39.1±2.2)%respectively,and those in control group were(120.7±4.4)g/L,(15.5±6.1)g/L and(37.8±14.2)%respectively.There was no significant difference between AI group and AI+II Group(P>0.05).The postoperative Hb concentration and HCT of Ai Group and AI+II group were higher than those of the control group,and the decrease degree of Hb was lower than that of the control group.The difference was statistically significant(P<0.05).APTT,PT and D-dimer in AI group were(29.7±1.2)s,(12.7±0.8)s and(473.2±74.9)ng/ml respectively,those in AI+II group were(28.6±1.5)s,(12.2±0.5)s and(603.0±148.7)ng/mL respectively,and those in control group were(29.8±1.4)s,(12.9±0.8)s and(486.0±80.0)ng/mL respectively.There was no significant difference between AI group and control group(P>0.05);The postoperative APTT and PT in AI group and control group were higher than those in AI+II group,and the postoperative D-dimer was lower than that in AI+II group.The difference was statistically significant(P<0.05).Conclusion In UKA,compared with AI+II,AI can reduce the risk of lower extremity deep venous thrombosis under the condition of reducing the same blood loss,which is similar to the control group.Therefore,we believe that the application of TXA only through AI in UKA can make the patients have less blood loss and safer in the perioperative period.