氨甲环酸局部与静脉联合用药在全膝关节置换术中的应用效果观察  

Application efficacy of combined intra-articular and intravenous administration of tranexamic acidin in total knee arthroplasty

作　　者：南海[1] 侯玲[1] 武文臣[1] 薛冬[1] NAN Hai;HOU Ling;WU Wen-chen;XUE Dong(Department of Orthopedics,Heji Hospital Affiliated to Changzhi Medical College,Changzhi 04600,China)

机构地区：[1]长治医学院附属和济医院骨科,山西长治046000

出　　处：《实用医院临床杂志》2021年第1期12-15,共4页Practical Journal of Clinical Medicine

基　　金：山西省卫生计生委科研基金资助项目(编号:2015120)。

摘　　要：目的探讨氨甲环酸局部与静脉联合用药在全膝关节置换术(TKA)中的应用效果。方法2015年2月至2019年2月在我院初次行TKA手术的80例患者,根据术中氨甲环酸给药途径分为4组,每组20例。A组在缝合关节囊后关节腔内注射生理盐水50 ml;B组在缝合关节囊后关节腔内注射氨甲环酸0.5 g;C组在术前0.5 h静脉注射氨甲环酸1.0 g,且在缝合关节囊后关节腔注射氨甲环酸0.5 g;D组在术前0.5 h和术后2 h均静脉注射氨甲环酸1.0 g,且在缝合关节囊后关节腔注射氨甲环酸0.5 g。TKA术后所有患者均给予放置引流管并加闭3 h。观察各组患者术中出血量、术后48 h引流量、隐性出血量、Hb、HCT、术后美国特种外科医院膝关节评分(HSS)及并发症发生情况。结果术中出血量、引流量、隐性出血量比较,依次是D组<C组<B组<A组;术后Hb、HCT水平比较,依次是D组>C组>B组>A组(P<0.05);4组患者均无深静脉血栓、胸闷、呼吸困难等并发症发生,HSS评分差异无统计学意义(P>0.05)。结论氨甲环酸局部和静脉联合应用比氨甲环酸单独局部应用更能有效减少患者TKA术中出血量、引流量、隐性出血量,促进患者术后Hb、HCT恢复,值得临床推广和运用。Objective To observe the efficacy and safety of combined intra-articular and intravenous administration of tranexamic acid(TXA)in total knee arthroplasty(TKA).Methods A total of 80 patients with unilateral knee osteoarthritis undergoing TKA operation in Heji Hospital of Changzhi Medical College from February 2015 to February 2019 were enrolled.The patients were divided into A,B,C and D groups based on the regimen of TXA.The group A was injected with 50 ml normal saline into the articular cavity after joint capsules were sutured.The group B was injected with 0.5 g TXA into the articular cavity after joint capsules were sutured.The group C was administrated with 1.0 g TXA intravenously at half an hour before operation and 0.5 g TXA was injected into the articular cavity after joint capsules were sutured.The group D was administrated with 1.0 g TXA intravenously at half an hour before operation and two hours after operation.At the same time,0.5 g TXA was injected into the articular cavity after joint capsules were sutured.After TKA,closed drainage was carried out for 3 hours in each group.The intraoperative blood loss and postoperative drainage volume,hidden blood loss,hemoglobin(Hb),hematocrit(HCT),prothrombin time(PT),and activated partial thromboplastin time(APTT)at 48 h after operation as well as USA hospital for special surgery knee score(HSS)and the complication were recorded.Results In comparison with intraoperative blood loss,postoperative drainage volume and hidden blood loss in the four groups,the groups ranked in ascending order were D<C<B<A(P<0.05).In comparison with Hb and HCT in the four groups,the groups ranked in descending order were D>C>B>A(P<0.05).Meanwhile,there was no significant difference in the incidence of deep vein thrombosis(DVT),chest tightness,dyspnea and HSS among the four groups(P>0.05).Conclusion Combined intra-articular and intravenous administration of TXA in TKA can not only significantly decrease the intraoperative blood loss and postoperative drainage volume and hidden blood loss

关 键 词：膝关节表面置换术 氨甲环酸 失血量 深静脉血栓 

分 类 号：R687.4[医药卫生—骨科学]