氨甲环酸关节腔灌洗联合静脉滴注对全膝关节置换术后失血量及炎性因子和凝血功能的影响

Changes of Blood Loss,Inflammatory Cytokines and Blood Coagulation Indexes of Articular Cavity Lavage Combined with Intravenous Tranexamic Acid in Total Knee Arthroplasty

目的探讨全膝关节置换术(TKA)进行术中关节腔灌洗联合术后静脉滴注氨甲环酸对失血量及炎性因子和凝血功能的影响。方法选择2018年2月至2019年2月在我院骨科住院进行单侧全膝关节置换患者,术中给予关节腔氨甲环酸灌洗后,术后根据静脉滴注氨甲环酸剂量分组(10 mg/kg为观察组1、15 mg/kg为观察组2和空白对照组),比较不同分组患者术后24 h,48 h伤口引流量、术前和术后第3天炎性因子干扰素γ(IFN-γ)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、凝血功能指标纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和C-反应蛋白(CRP)水平。结果观察组1和观察组2术后24 h、48 h引流量均明显低于对照组,术后48 h观察组1和观察组2血红蛋白水平均高于对照组,且观察组2术后24 h、48 h引流量也明显低于观察组1,观察组2术后48 h血红蛋白水平也高于观察组1,差异均有统计学意义(P<0.05)。与对照组比较,观察组1和观察组2术后IFN-γ的水平均明显高于对照组;而术后IL-1β、IL-6水平明显低于对照组。与观察组1术后比较,观察组2患者术后IL-1β、IL-6水平均明显降低,差异均有统计学意义(P<0.05)。观察组2术后APTT、CRP均明显低于对照组和观察组1术后水平,差异有统计学意义(P<0.05)。对照组术后PT高于观察组1和观察组2,差异有统计学意义(P<0.05)。结论关节腔灌洗联合静脉滴注10 mg/kg和15 mg/kg氨甲环酸均能明显降低TKA患者术中和术后的出血量,控制炎性因子水平,改善凝血功能,且关节腔灌洗联合静脉滴注15 mg/kg氨甲环酸较优,值得临床借鉴。

Objective To investigate changes of blood loss,inflammatory cytokines and coagulation function indexes of articular cavity lavage combined with intravenous drip of different tranexamic acid in total knee arthroplasty.Methods From February 2018 to February 2019,patients with knee osteoarthritis who underwent unilateral TKA in our orthopedics department were selected as research objects,and they were randomly divided into control group,observation group 1 and observation group 2.The postoperative blood loss in 24 hours and 48 hours,preoperative and postoperative inflammatory factors(IFN-γ,IL-1β,IL-6),coagulation function indicators fibrinogen,prothrombin time,activated partial thromboplastin time Thrombin time and C-reactive protein(CRP)were compared.Results The postoperative drainage volume at 24 hours and 48 hours in observation group 1 and observation group 2 were significantly lower than those in the control group.The hemoglobin levels in observation group 1 and observation group 2 were higher than those in the control group 48 hours after surgery,and the drainage volume at 24 hours and 48 hours in observation group 2 was also significantly lower than that in observation group 1.The hemoglobin levels in observation group 2 at 48 hours after surgery were also higher than those in observation group 1,and the differences were statistically significant(P<0.05).Compared with control group,postoperative IFN-γin observation group 1 and observation group 2 were significantly higher than those in control group-γ.And IL-1β、IL-6 were significantly lower than those of control group after surgery.Compared with observation group 1 after surgery,observation group 2 patients had IL-1 after surgeryβ、The average level of IL-6 water decreased significantly,and the differences were statistically significant difference(P<0.05).Postoperative APTT and CRP in observation group 2 were significantly lower than those in control group and observation group 1 with statistical significance(P<0.05).The postoperative PT of control group was higher than that of observation group 1 and observation group 2 with statistically significant difference(P<0.05).Conclusion Joint cavity lavage combined with intravenous drip of 10 mg/kg and 15 mg/kg tranexamic acid could both significantly reduce intraoperative and postoperative blood loss of TKA patients,control inflammatory factors,and improve coagulation function.In addition,joint cavity lavage combined with intravenous drip of 15 mg/kg tranexamic acid is better,which is worthy of clinical reference.