氨甲环酸对初次全膝关节置换术后引流管拔除时机的影响  

Effects of tranexamic acid on the drainage duration after total knee arthroplasty

作　　者：王金良[1] 李哲[1] 骆晓飞[1] 蔡松涛[1] 魏瑄[1] Wang Jinliang;Li Zhe;Luo Xiaofei;Cai Songtao;Wei Xuan(Department of Joint Surgery II,Zhengzhou Orthopaedic Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市骨科医院关节二科,450000

出　　处：《中华骨科杂志》2020年第10期635-643,共9页Chinese Journal of Orthopaedics

基　　金：郑州市科技攻关项目(20150138)。

摘　　要：目的探讨初次单侧全膝关节置换术中应用氨甲环酸对术后引流管拔除时机的影响。方法纳入2017年6月至2018年12月拟行初次单侧全膝关节置换术的患者182例,男42例,女140例;年龄(68.1±7.1)岁(范围60~76岁)。按随机数字表法分为四组:氨甲环酸1组45例、氨甲环酸2组46例、氨甲环酸3组46例和非氨甲环酸组45例,分别于术后12 h、18 h、24 h、24 h拔除引流管。氨甲环酸1~3组术前30 min静脉滴注联合局部应用氨甲环酸;非氨甲环酸组术后仅以100 ml生理盐水关节腔内局部灌注。比较四组引流量、总失血量、隐性失血量、术后关节肿胀度、美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分、疼痛视觉模拟评分(visual analogue scale,VAS)的差异。结果氨甲环酸1~3组术后引流量分别为(85.5±34.3)ml、(189.4±72.3)ml、(215.3±93.4)ml,少于非氨甲环酸组的(351.3±113.5)ml,差异有统计学意义(F=11.5,P=0.005),其中氨甲环酸1组术后引流量少于氨甲环酸2组和氨甲环酸3组;氨甲环酸1~3组术后总失血量分别为(699.0±255.7)ml、(710.4±296.1)ml、(715.8±248.2)ml,少于非氨甲环酸组的(1130.5±354.2)ml,差异有统计学意义(F=13.1,P=0.001)。氨甲环酸1~3组术后第4天膝关节肿胀度分别为1.25±0.07、1.13±0.12、1.12±0.13,小于非氨甲环酸组的1.43±0.22,差异有统计学意义(F=8.23,P=0.015),其中氨甲环酸1组大于氨甲环酸2组和氨甲环酸3组。非氨甲环酸组和氨甲环酸3组分别出现细菌培养阳性2例;非氨甲环酸组出现血肿3例,其中伤口延迟愈合1例。结论全膝关节置换术后氨甲环酸的应用能减少术后引流量、隐性失血量及总失血量;术后18 h拔除引流管既能充分引流、减轻疼痛、促进膝关节功能恢复,又能有效降低引流管导致的感染风险。Objective To investigate the effects of tranexamic acid on the drainage duration after primary unilateral total knee arthroplasty(TKA).Methods From June 2017 to December 2018,a total of 182 patients(42 males and 140 females)who underwent primary TKA were included.The age of patients was 68.1±7.1 years(60-76 years).According to the random number table,the subjects were divided into four groups:45 cases in tranexamic acid group 1(TXA1),46 cases in tranexamic acid group 2(TXA2),46 cases in tranexamic acid group 3(TXA3)and others in none tranexamic acid group(NTXA).The patients in TXA1-3 groups received intravenous infusion combined with local application of tranexamic acid.The patients in NTXA group were locally perfused in the joint cavity with 100 ml normal saline after surgery.The drainage volume,total blood loss,invisible blood loss,degree of postoperative joint swelling,Hospital for Special Surgery(HSS)and visual analogue scale(VAS)of pain were compared among the four groups.Results The postoperative drainage volume of TXA1-3 groups was 85.5±34.3 ml,189.4±72.3 ml and 215.3±93.4 ml,respectively,which were less than that of the NTXA group(351.3±113.5 ml)with significant difference(F=11.5,P=0.005).The postoperative drainage volume of TXA1 group was less than that of TXA2-3 groups.The total postoperative blood loss was 699.0±255.7 ml,710.4±296.1 ml,and 715.8±248.2 ml in the TXA1-3 groups,respectively,which were less than that of the NTXA group(1130.5±354.2 ml)with significant difference(F=13.1,P=0.001).At the 4th day after TKA,the knee swelling degree of TXA1-3 groups was 1.25±0.07,1.13±0.12,and 1.12±0.13,respectively,which were less severe than that of the NTXA group(1.43±0.22)with significant difference(F=8.23,P=0.015).There were 2 cases with positive bacterial culture in NTXA group and TXA3,3 cases with hematoma and 1 case with delayed wound healing in the NTXA group.Conclusion The application of tranexamic acid after TKA can reduce postoperative drainage volume,latent blood loss and total blood los

关 键 词：氨甲环酸 关节成形术 置换 膝 引流术 失血 手术 感染 

分 类 号：R687.4[医药卫生—骨科学]