氨甲环酸局部应用联合弹力绷带对全膝关节置换术围术期失血量、膝关节肿胀及静脉血栓性疾病发生的影响研究  

Effect of Topical application of tranexamic acid combined with elastic bandage on perioperative blood loss,knee swelling and venous thrombotic disease in total knee arthroplasty.

作　　者：曹良国 姚依村 王文 叶伟雄 CAO Liang-guo;YAO Yi-cun;WANG Wen(Department of Orthopedics,Guangzhou Red Cross Hospital,Guangzhou Guangdong 510000,China.)

机构地区：[1]广州市红十字会医院骨科,广东广州510000

出　　处：《临床和实验医学杂志》2021年第15期1655-1658,共4页Journal of Clinical and Experimental Medicine

基　　金：广东省医学科学技术研究基金项目(编号:B2019064)。

摘　　要：目的探究氨甲环酸局部应用联合弹力绷带对全膝关节置换术(TKA)围手术期失血量、膝关节肿胀及静脉血栓性疾病发生的影响。方法回顾性选取2019年3月至2020年11月于广州市红十字会医院行TKA的110例患者为研究对象,分析其临床资料,按围手术期干预方式的不同分为对照组(n=55)和观察组(n=55)。观察组在关闭关节囊切口前向关节腔内局部灌注氨甲环酸(10 mL/kg)+100 mL 0.9%氯化钠溶液,在松止血带前用弹力绷带对患肢进行包扎;对照组在关节腔内局部灌注100 mL 0.9%氯化钠溶液,不使用弹力绷带。比较2组围手术期失血量、膝关节肿胀情况(术后2、4、8 d)、静脉血栓性疾病发生率及凝血指标[术后1、2、3 d,纤维蛋白原(Fb)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)]。结果观察组术后引流量、显性失血量、隐性失血量、总失血量分别为(24.13±6.79)、(112.28±15.45)、(102.87±32.13)、(215.15±43.23)mL,均明显低于对照组[(31.24±7.65)、(119.85±14.66)、(128.64±29.68)、(248.49±47.89)mL],差异均有统计学意义(P<0.05)。观察组在术后第2、4、8天的膝关节肿胀程度(1.06±0.11、1.14±0.14、1.09±0.08)均较对照组(1.22±0.13、1.37±0.21、1.25±0.12)更低,差异均有统计学意义(P<0.05)。观察组和对照组静脉血栓性疾病总发生率比较差异无统计学意义(12.73%vs 7.27%,P>0.05)。观察组在术后1、2、3 d时Fb、PT、APTT水平与对照组比较,差异均无统计学意义(P>0.05)。结论氨甲环酸局部应用联合弹力绷带可有效减少TKA围手术期失血量,坚强膝关节肿胀,对凝血功能影响极小,且不增加静脉血栓性疾病发生风险,临床应用安全、有效。Objective To explore the effect of topicalapplication of tranexamic acid combined with elastic bandage on perioperative blood loss,knee swelling and venous thrombotic disease in total knee arthroplasty(TKA).Methods The clinical data of 110 patients who underwent TKA in Guangzhou Red Cross Hospital from March 2019 to November 2020 were retrospectively analyzed and divided into the control group(n=55)and the observation group(n=55)according to the different ways of perioperative intervention.In the observation group,tranexamic acid(10 mL/kg)+100 mL 0.9%sodium chloride solution was infused into the joint cavity before closing the joint capsule incision,and elastic bandage was used to bandage the affected limb before loosening the tourniquet;in the control group,100 mL 0.9%sodium chloride solution was infused into the joint cavity,without useelastic bandage.The perioperative blood loss,knee joint swelling(2,4 and 8 days after operation),incidence of venous thrombotic disease and coagulation indexes[1,2 and 3 days after operation,fibrinogen(FB),prothrombin time(PT),activated partial thromboplastin time(APTT)]were compared between the two groups.Results The postoperative drainage volume,apparent blood loss,hidden blood loss,and total blood loss in the observation group were(24.13±6.79),(112.28±15.45),(102.87±32.13),and(215.15±43.23)mL,respectively,which were significantly lower in the control group[(31.24±7.65),(119.85±14.66),(128.64±29.68),(248.49±47.89)mL],the differences were statistically significant(P<0.05).The degree of knee swelling in the observation group(1.06±0.11,1.14±0.14,1.09±0.08)was lower than that in the control group(1.22±0.13,1.37±0.21,1.25±0.12)on the 2nd,4th and 8th day after operation,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of venous thrombotic disease between the observation group and the control group(12.73%vs 7.27%,P>0.05).There was no significant difference in the levels of FB,Pt and APTT between the observa

关 键 词：氨甲环酸 弹力绷带 全膝关节置换术 围手术期 失血 静脉血栓 

分 类 号：R687.4[医药卫生—骨科学]