单一静脉与联合关节腔注射氨甲环酸对减少初次单侧全膝关节置换术后失血的临床研究

Clinical Study of Tranexamic Acid Injection through Single Intravenous and Joint Cavity to Reduce Blood Loss after Primary Unilateral Total Knee Replacements

目的 研究分析初次单侧全膝关节置换术后失血患者,采用单一静脉注射(intravenous injection, IV)与联合关节腔注射(intra-articular injection, IA)氨甲环酸(tranexamic acid, TXA)的临床效果。方法 随机选取2021年6月—2022年6月在齐齐哈尔市第一医院行初次单侧全膝关节置换术的患者68例为研究对象,并将单号病房患者作为IV TXA组(32例),将双号病房患者作为IA TXA与IV TXA联合组(36例)。对比两组患者的输血率、引流量、术后住院时间以及减少术后血红蛋白下降的效果。结果 IA TXA与IV TXA联合组患者平均术后引流量少于IVTXA组[(97.23±17.34)mLvs (150.67±20.1)mL],差异有统计学意义(t=11.770,P<0.001)。两组患者术前Hb与HCT比较,差异无统计学意义(P>0.05);术后第1、3天,IA TXA与IV TXA联合组Hb与HCT均高于IV TXA组,差异有统计学意义(t=9.133、8.618、4.705、23.173,P<0.001);IA TXA与IV TXA联合组术后平均住院时间短于IV TXA组[(6.89±0.37)d vs (7.58±0.49)d],差异有统计学意义(t=6.596,P<0.001)。结论 关节腔注射联合静脉注射能有效减少初次单侧全膝关节置换术后失血情况,为其在临床进一步应用提供相应依据及相关建议。

Objective To study and analyze the clinical effects of intravenous injection(IV)and intra-articular injec⁃tion(IA)of tranexamic acid(TXA)in patients with blood loss after primary unilateral total knee arthroplasty.Methods Randomly select 68 patients who underwent the first unilateral total knee arthroplasty in the First Hospital of Qiqihar City from June 2021 to June 2022 as the study subjects,and the patients in the single-number ward were treated as IV TXA group(32 cases),and the patients in the double-number ward were treated as IA TXA and IV TXA combined group(36 cases).The blood transfusion rate,drainage volume,postoperative hospitalization time and the effect of re⁃ducing postoperative hemoglobin drop were compared between the two groups.Results The average postoperative drain⁃age volume of patients in the IA TXA and IV TXA combined group was less than that in the IV TXA group[(97.23±17.34)mL vs(150.67±20.1)mL],and the difference was statistically significant(t=11.770,P<0.001).There was no statistically significant difference in preoperative Hb and HCT between the two groups(P>0.05);on the 1 d and 3 d af⁃ter operation,Hb and HCT in the IA TXA and IV TXA combined group were higer than those in the IV TXA group,the difference was statistically significant(t=9.133,8.618,4.705,23.173,P<0.001).The average postoperative hospitalization time of IA TXA and IV TXA combined group was shorter than that of IV TXA group[(6.89±0.37)d vs(7.58±0.49)d],and the difference was statistically significant(t=6.596,P<0.001).Conclusion Joint cavity injection combined with intravenous injection can effectively reduce blood loss after primary unilateral total knee replacement,providing relevant evidence and suggestions for further clinical application.