氨甲环酸联合改良鸡尾酒疗法在全髋关节置换术后康复的疗效分析

Efficacy Analysis of Tranexamic Acid Combined with Modified Cocktail in Rehabilitation after Total Hip Arthroplasty

目的探讨使用氨甲环酸联合改良鸡尾酒疗法在初次全髋关节置换术(total hip arthroplasty,THA)中的临床疗效.方法前瞻性纳入69例全髋关节置换术患者的临床资料,根据随机数字表法将患者分为改良组、传统组、对照组,每组23例,改良组术中给予氨甲环酸和改良鸡尾酒关节周围浸润注射;传统组给予罗哌卡因、肾上腺素以及生理盐水混合液的关节周围浸润注射;对照组给予等量生理盐水的关节周围浸润注射.观察3组术后静息和活动视觉模拟评分法(visual analogue scale,VAS)评分、Harris评分、术后48 h出血量和镇痛药物补救使用情况、术后不良反应等.结果术后24、48、72 h的静息和活动时VAS评分改良组显著小于传统组、对照组(P<0.05);术后7、14、28 d的Harris评分改良组优于传统组、对照组(P<0.05);术后48 h出血量及镇痛药物使用量改良组显著少于传统组、对照组(P<0.05);术后3组不良反应发生率比较差异无统计学意义(P>0.05).结论全髋关节置换术使用氨甲环酸和改良鸡尾酒混合剂在术后早期镇痛和减少出血量方面效果明显,安全有效.

Objective To investigate the clinical efficacy of tranexamic acid combined with modified cocktail therapy in primary total hip arthroplasty(THA).Method The clinical data of 69 patients undergoing total hip arthroplasty were prospectively included.The patients were divided into improved group,traditional group and control group according to the random number table method,with 23 patients in each group;In the improved group,tranexamic acid and modified cocktails were injected around the joint during operation;In the traditional group,the mixture of ropivacaine,adrenaline and normal saline was injected around the joint;The control group was injected with the same amount of normal saline around the joint.The rest and activity visual analog scale score,Harris score,the amount of bleeding 48 hours after operation,the use of analgesics and adverse reactions after operation were observed in the three groups.Results At 24,48,72 hours after operation,the VAS score of the improved group was significantly lower than that of the traditional group and the control group(P<0.05);At 7,14,28 days after operation,the modified Harris score was superior to the traditional group and the control group(P<0.05);The amount of bleeding 48 hours after operation and the amount of analgesics used in the improved group were significantly less than those in the traditional group and the control group(P<0.05);There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion The mixture of tranexamic acid and modified cocktails is safe and effective in early postoperative analgesia and bleeding reduction in total hip replacement.