关节腔灌注鸡尾酒联合氨甲环酸对全膝关节置换患者术后疼痛及失血量影响的前瞻性研究

Effect of intra-articular infusion cocktail combined with tranexamic acid on postoperative pain and blood loss in patients with total knee arthroplasty

目的观察关节腔灌注鸡尾酒联合氨甲环酸对全膝关节置换术(total knee arthroplasty,TKA)患者术后疼痛及失血量的影响。方法纳入自2021年3月至9月因骨关节炎行初次TKA术后的100例患者,根据双盲随机分为两组,每组50例。试验组术中于关节腔内灌注含罗哌卡因、复方倍他米松、肾上腺素和氨甲环酸的鸡尾酒溶液50 ml,对照组于关节腔内灌注生理盐水50 ml,两组关节腔内均不放置引流管。对两组术后疼痛目测类评分、术后膝关节最大屈曲度、术后失血量、血红蛋白下降值、输血率及术后并发症等情况进行观察和比较。结果术后疼痛目测类比评分试验组6 h(4.0±0.3),12 h(5.3±0.3),24 h(6.9±0.5)均低于对照组6 h(4.8±0.5),12 h(6.6±0.4),24 h(7.9±0.6),试验组术后24 h(59.13±9.59)°,48 h(82.48±7.25)°膝关节最大屈曲度均大于对照组24 h(49.54±10.32)°,48 h(72.88±8.09)°,试验组术后1天(343.7±73.2)ml,3天(656.0±271.2)ml的总失血量均少于对照组1天(657.3±107.4)ml,3天(1012.0±284.6)ml,试验组术后1天(7.8±5.9)g/L,3天(14.3±14.7)g/L血红蛋白下降值均低于对照组1天(10.2±4.8)g/L,3天(18.7±12.6)g/L,差异有统计学意义(P<0.05)。试验组输血率低于对照组,但差异无统计学意义(P>0.05),术后48 h,72 h疼痛目测类比评分、术后72 h膝关节最大屈曲度差异无统计学意义(P>0.05)。两组术后下肢静脉血栓发生率差异无统计学意义,两组均未发生手术切口感染、关节腔血肿等并发症。结论采用关节腔灌注鸡尾酒联合氨甲环酸的治疗方式,能够有效缓解TKA术后患者早期疼痛,减少围术期失血量,且未增加相关并发症的风险。

Objective To observe the effect of intra-articular infusion cocktail combined with tranexamic acid on pain and blood loss after total knee arthroplasty(TKA).Methods A total of 100 patients who underwent primary total knee arthroplasty for osteoarthritis from March to September 2021 were included,and all were divided into 2 groups of 50 patients each according to double-blind randomization.In the test group,50 ml of a cocktail solution containing ropivacaine,compound betamethasone,epinephrine and tranexamic acid was instilled into the joint cavity intraoperatively;in the control group,50 ml of saline was instilled into the joint cavity;no drainage tube was placed in the joint cavity in both groups.The visual analogue scale,postoperative maximum knee flexion,postoperative blood loss,hemoglobin decline,blood transfusion rate and postoperative complications were observed and compared between the two groups.Results Postoperative VAS was lower in the test group at 6 h(4.0±0.3),12 h(5.3±0.3)and 24 h(6.9±0.5)than in the control group at 6 h(4.8±0.5),12 h(6.6±0.4)and 24 h(7.9±0.6);the maximum knee flexion was greater in the test group at 24 h(59.13±9.59)°and 48 h(82.48±7.25)°than in the control group at 24 h(49.54±10.32)°and 48 h(72.88±8.09)°;the total blood loss was less in the test group at 1 d(343.7±73.2)ml and 3 d(656.0±271.2)ml than in the control group at 1 d(657.3±107.4)ml and 3 d(1012.0±284.6)ml postoperatively.The hemoglobin drop in the test group at 1 d(7.8±5.9)g/L and 3 d(14.3±14.7)g/L was lower than that of the control group at 1 d(10.2±4.8)g/L and 3 d(18.7±12.6)g/L postoperatively,and the differences were statistically significant(P<0.05).There was no statistically significant difference in VAS at 48 h and 72 h postoperatively,and the maximum knee flexion at 72 h postoperatively(P>0.05).There was no statistically significant difference in the incidence of postoperative venous thrombosis in the lower limbs between the two groups,and no complications such as surgical incision infection and joint cavity hematoma occurred in either group.Conclusions The treatment of intra-articular infusion cocktail combined with tranexamic acid can effectively alleviate the early pain of patients after total knee arthroplasty and reduce the perioperative blood loss,which will not increase the risk of related complications.