老年膝关节置换术患者氨甲环酸不同给药途径的疗效研究

A study of the efficacy of different routes of administration of tranexamic acid in elderly patients undergoing knee arthroplasty

目的比较老年全膝关节置换术(total knee arthroplasty,TKA)患者氨甲环酸(tranexamic acid,TXA)不同给药途径的疗效。方法选取我院2021年2月至2024年2月间收治的114例TKA患者。根据随机数字表法将患者分为3组,每组各38例。静脉滴注(intravenous drip,IV)TXA 1 g(IV组)、关节腔内注射(intra-articular injection,IA)TXA 2 g(IA组)和IV TXA 1 g联合IA TXA 1 g(IV+IA组)。比较3组患者围术期指标、关节肿胀程度、疼痛视觉模拟评分(visual analogue scale,VAS)以及膝关节评分系统(Keen Society score,KSS)。结果IV+IA组患者术中失血量、隐性失血量、引流液量、总输血人数和住院天数低于IV组和IA组患者(P<0.05);IV+IA组并发症发生率低于IV组和IA组(13.2%vs.39.5%vs.36.8%,P=0.013);术后1天和7天IV+IA组患者凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、国际标准化比率(international normalized ratio,INR)、D-二聚体(D-dimer,D-D)和C-反应蛋白(C-reactive protein,CRP)低于IV组和IA组患者,纤维蛋白原(fibrinogen,Fib)高于IV组和IA组患者(P<0.05)。术后3天、14天、1个月和3个月IV+IA组患者膝关节肿胀低于IV组和IA组患者(P<0.05);术后3天、14天和1个月IV+IA组患者VAS评分低于IV组和IA组患者(P<0.05);术后3天、14天、1个月和3个月IV+IA组患者KSS高于IV组和IA组患者(P<0.05)。结论与IV组和IA组相比,IV联合IA TXA可以显著减少TKA患者术中和术后出血、输血和并发症风险,降低患者疼痛程度,加速患者膝关节功能的恢复,具有更好的疗效。

Objective To compare the efficacy of different routes of tranexamic acid(TXA)administration in elderly total knee arthroplasty(TKA)patients.Methods 114 TKA patients admitted to our hospital between February 2021 and February 2024 were selected.The patients were divided into 3 groups according to the random number table method with 38 cases in each group,including intravenous(IV)drip TXA 1 g group(IV group),intra-articular(IA)injection TXA 2 g group(IA group)and IV TXA 1 g combined with IA TXA 1 g group(IV+IA group).Perioperative indicators,joint swelling,visual analogue scale(VAS)of pain and Knee Society score(KSS)were compared among the three groups.Results Intraoperative blood loss,occult blood loss,drainage fluid volume,transfusion frequency and hospital day were lower for patients in the IV+IA group than those in the IV and IA group(P<0.05);the complication rate was lower in the IV+IA group than in the IV and IA groups(13.2%vs.39.5%vs.36.8%,P=0.013);the prothrombin time(PT),activated partial thromboplastin time(APTT),international normalised ratio(INR),D-dimer(D-D)and C-reactive protein(C-RP)of the IV+IA group were lower than those of patients in IV group and IA group,while the fibrinogen(Fib)was higher than those of patients in group IV and IA one and seven days postoperatively(P<0.05).Knee swelling was lower in patients in the IV+IA group than in patients in the IV and IA groups at 3 days,14 days,1 month,and 3 months after surgery(P<0.05).VAS was lower in patients in the IV+IA group than in patients in the IV and IA groups at 3 days,14 days,and 1 month after surgery(P<0.05).KSS was higher in patients in the IV+IA group than in patients in the IV and IA groups at 3 days,14 days,1 month,and 3 months after surgery(P<0.05).Conclusions Compared with IV and IA group,IV combined with IA TXA can significantly reduce intraoperative and postoperative bleeding,blood transfusion,pain and complications in patients with TKA,accelerating the recovery of knee function with better efficacy.