探讨全髋关节及全膝关节置换手术后应用氨甲环酸、富血小板纤维蛋白、血液回输联合干预对患者的隐性失血情况以及其临床疗效

Exploring the Application of Tranexamic Acid,Platelet-rich Fibrin,and Blood Reinfusion Combined Intervention after Total Hip and Total Knee Replacement Surgery on Patients' Occult Blood Loss and Its Clinical Efficacy

目的 探讨氨甲环酸、富血小板纤维蛋白及血液回输干预对全髋关节及全膝关节置换手术患者术后隐性失血的临床治疗效果。方法 随机选取2021年1月—2023年4月期间于中山市骨科医院行全髋或全膝关节置换术患者50例为研究对象,术前随机划分患者为参照组(25例)、研究组(25例)。术中参照组行氨甲环酸干预,研究组行氨甲环酸、富血小板纤维蛋白、血液回输联合干预。对比两组围术期显性、隐性失血量、Hb指标下降值、术后康复指标及纤溶、炎症因子指标、手术不良预后发生率。结果 研究组围术期显性失血量、隐性失血量、失血总和及Hb最大下降值均低于参照组,术后Hb检验值高于参照组,差异有统计学意义(P<0.05)。研究组术后住院时间、术后引流量及血制品总输注量均优于参照组,差异有统计学意义(P<0.05)。术后1 d,两组纤溶、炎症因子指标均升高,且研究组低于参照组,差异有统计学意义(P<0.05)。术后,研究组手术相关不良预后发生率为0低于参照组的16.67%,差异有统计学意义(χ^(2)=2.446,P<0.05)。结论 全髋、全膝关节置换手术中予以患者氨甲环酸、富血小板纤维蛋白、血液回输联合干预,可积极减少患者显性失血、隐性失血,减轻术后炎症反应风险,降低手术相关不良预后发生率。

Objective To investigate the clinical therapeutic effects of tranexamic acid,platelet-rich fibrin and blood reinfusion interventions on postoperative occult blood loss in patients undergoing total hip and total knee arthroplasty.Methods Fifty patients who underwent total hip or knee arthroplasty at Zhongshan Orthopedic Hospital from January 2021 to April 2023 were randomly selected as the study subjects.Patients were randomly divided into a reference group(25 cases) and a study group(25 cases) before surgery.During the surgery,the reference group received tranexamic acid intervention,while the study group received a combination of tranexamic acid,platelet rich fibrin,and blood transfusion intervention.Compared the perioperative explicit and implicit blood loss,decrease in Hb indicators,postoperative rehabilitation indicators,fibrinolytic and inflammatory factor indicators,and incidence of poor surgical prognosis between the two groups.Results The perioperative explicit blood loss,implicit blood loss,total blood loss,and maximum decrease in Hb in the study group were lower than those in the control group,and the postoperative Hb test value was higher than that in the control group,the difference was statistically significant(P<0.05).The study group had better postoperative hospitalization time,postoperative drainage volume,and total blood product infusion volume than the control group,the difference was statistically significant(P<0.05).On the first day after surgery,the fibrinolytic and inflammatory factor indicators in both groups increased,and the study group was lower than the control group,the difference was statistically significant(P<0.05).After surgery,the incidence of surgical related adverse prognosis in the study group was 0,lower than 16.67% in the reference group,the difference was statistically significant(χ^(2)=2.446,P<0.05).Conclusion The combined intervention of tranexamic acid,platelet rich fibrin,and blood transfusion during total hip and knee arthroplasty surgery can actively reduce patients' explicit and implicit blood loss,reduce the risk of postoperative inflammatory response,and reduce the incidence of surgical related adverse prognosis.