氨甲环酸局部注射对初次单侧全膝关节置换术后失血量的影响

Effect of tranexamic acid topically using combine with high va-cuum wound drainage system to blood loss on postoperative after unilateral primary total knee arthroplasty

摘要:

目的  探讨氨甲环酸局部注射对初次单侧全膝关节置换术后失血量的影响。方法  采用随机对照研究2013年12月-2016年08月在湖南省人民医院关节外科因骨关节炎行单侧初次关节置换术的60例患者，根据在关节腔关闭之前，关节囊局部是否注射氨甲环酸进行随机分组，分为实验组和对照组，各30例。实验组：在关节腔关闭之前，关节囊局部注射10 ml（1.0 g）氨甲环酸并放置高负压引流瓶；对照组：在关节腔关闭之前，关节囊囊壁周围局部注射10 ml生理盐水，同样放置高负压引流瓶。记录两组患者的术前血红蛋白、术后引流量及术后第1、4及7天血红蛋白和总失血量，并比较其术后输血率、输血量及发生深静脉血栓的概率。结果  实验组术后24 h引流量、隐性失血量及总失血量均低于对照组，差异有统计学意义（P <0.05）；两组患者术前血红蛋白、红细胞比容（HCT）比较，差异无统计学意义（P >0.05），术后第1、4及7天血红蛋白、HCT比较，实验组均高于对照组，差异有统计学意义（P <0.05）；实验组输血率和接受输血量均低于对照组，差异有统计学意义（P <0.05）；两组患者术后深静脉血栓发生率分别为16.7%及10%，差异无统计学意义（P >0.05）。结论  高负压引流基础上联合氨甲环酸局部注射可以降低单侧初次全膝关节置换术后出血及输血需求，并不增加深静脉血栓的发生率。

Abstract:

Objective To discuss the effect of combined usage of tranexamic acid (TXA) topically and high vacuum wound drainage system (REDON SET) to the blood loss on postoperative after unilateral primary total knee arthroplasty. Methods From Dec 2013 to Aug 2016, 60 patients suffered from osteoarthitis arthritis (OA) underwent primaral total knee arthroplasty (TKA) were collected. According to whether injected the TXA topically or not before closure, patients were divided into two groups. Group A (experimental group) was treated with topical injection of the TXA 10 ml (1.0 g) combined with Redon Set before closure. Group B (blank group) was treated with topical injection of the saline (10 ml) combined with Redon Set before closure. The volume of drainage and hemoglobin after operation, pre-operation and first, fourth, seventh day post-operatively and total blood loss were recorded. The rates of blood transfusion, transfusion volume and rate of the incidence of deep vein thrombosis were compared. Results Compared with group B, the total drainage volume, the hidden blood loss, total blood loss in 24 h after operation in group A had statically significant difference (P < 0.05). The hemoglobin pre-operation and HCT in two groups had no statistically significant (P > 0.05), but the hemoglobin and HCT in the first, fourth, seventh days postoperatively had significant difference (P < 0.05). The rate of blood transfusion and transfusion volume in the group A were less than those in group B (P < 0.05). The prevalence of throboembolic complications were 16.67%, 10.00% (P > 0.05) respectively. Conclusions Topical injection of the TXA combined with Redon Set is effective for reducing postoperative blood loss and transfusion requirement without increasing prevalence of throboembolic complications in the unilateral primary total knee arthroplasty.