全膝人工关节置换氨甲环酸静脉局部联合应用的效果

Outcomes of intravenous and local tranexamic acid in total knee arthroplasty

[目的]探讨氨甲环酸(tranexamic acid, TXA)静脉滴注联合局部注射对全膝人工关节置换术(total knee arthroplasty, TKA)患者临床疗效的影响。[方法]前瞻性选取2016年6月～2017年7月在南华医院行初次单侧TKA的108例患者,随机分两组,每组54例。观察组分别静脉和局部给予20 mg/kg TXA,对照组未给予TXA。比较两组患者围手术期失血量、术后并发症以及临床评分。检测比较血清D-二聚体(DD)、纤维蛋白原降解产物(FDP)、C-反应蛋白(CRP)和白介素-6(IL-6)以及白蛋白(Alb)含量。[结果]观察组患者围手术期理论总失血量(TBL)、术中失血量(IBL)、术后引流量(PDV)、隐性失血量(HDL)和输血率均显著低于对照组,差异有统计学意义(P<0.05)。两组患者术后并发症总发生率差异无统计学意义(P>0.05)。术后1年,观察组的HSS评分和WOMAC评分优于对照组,差异有统计学意义(P<0.01)。实验室检验方面,术后即刻、6 h、12 h和24 h观察组患者血清DD、FDP和IL-6显著低于对照组(P<0.05);术后12 h和术后24 h观察组血清CRP低于对照组,而Alb高于对照组,差异有统计学意义(P<0.05)。[结论]对TKA患者静脉滴注联合局部注射20 mg/kg的TXA能够有效减少围手术期出血量和输血量,显著降低炎症反应,且不增加术后并发症总发生率,改善疗效。

[Objective]To investigate the clinical outcomes of intravenous and local tranexamic acid(TXA)in total knee arthroplasty(TKA).[Methods]A total of 108 patients who underwent primary unilateral TKA at Nanhua Hospital from June2016 to July 2017 were prospectively selected and randomly divided into two groups with 54 patients in each group.The trial group received TXA 20 mg/kg intravenously and locally individually,while the control group was not given TXA.The perioperative blood loss,postoperative complications and outcome scores were compared between the two groups.In addition,the peripheral venous blood was taken at 1 hour before surgery,immediately after surgery,as well as 6,12 and 24 hours after surgery for measuring serum D-dimer(DD),fibrinogen degradation product(FDP),C-reactive protein(CRP),interleukin-6(IL-6),and albumin(Alb).[Results]The trial group had significantly less blood loss than the control group,including theoretical total blood loss(TBL),intraoperative blood loss(IBL),postoperative drainage volume(PDV),and hidden blood loss(HDL)(P<0.05),associated with significantly less blood transfusion in the former than the latter(P<0.05).At 1 week postoperatively,1 patient in the trail group and 3 patients in the contol group proved deep venous thrombosis,and the total incidence of complications was not significantly different between the two groups(P>0.05).In term of clinical follow-up,the HSS score significantly increased,whereas WOMAC score significantly decreased at 1 year after operation in both groups compared with those before operation(P<0.05).The trial group was statistically superior to the control group in HSS and WOMAC scores at 1 year after operation(P<0.05),despite of no statistical differences between them before operation(P>0.05).Regarding to laboratory tests,the trial group proved significantly lower serum DD,FDP and IL-6 than the control group immediately after surgery,at 6,12 and 24 hours(P<0.051),the former had significantly lower serum CRP,whereas higher Alb than the latter at 12 h and24 hours postoperatively(P<0.05).[Conclusion]The combined administration of TXA by 20 mg/kg intravenously and locally respectively in TKA does effectively reduce the peri-operative bleeding and blood transfusion,accompanied with alleviated inflammation reaction and improved clinical outcomes without increase of postoperative complication.