氨甲环酸的不同使用途径对降低全膝关节置换术围术期失血的有效性  

Effectiveness of Different Ways of Using Tranexamic Acid in Reducing Perioperative Blood Loss in Total Knee Arthroplasty

作　　者：朱健波 吴发泳[1] 方良韬 ZHU Jianbo;WU Fayong;FANG Liangtao(Orthopedics District No.3,Sanming Second Hospital,Sanming,Fujian Province,366000 China)

机构地区：[1]三明市第二医院骨科三区,福建三明366000

出　　处：《中外医疗》2022年第8期99-102,共4页China & Foreign Medical Treatment

摘　　要：目的探讨氨甲环酸的不同使用途径对全膝关节置换术围术期控制失血的有效性对比。方法方便选择2018年2月—2020年2月该院收治的90例术前诊断为晚期退变性膝关节骨性关节炎疾病需行单侧TKA手术的患者作为研究对象,随机分组,每组30例。并且将氨甲环酸通过局部用药、静脉给药及联合用药这3种不同方式药,对3组术后24 h的综合表现加以综合观察并做好记录;比较3组患者术前及术后膝关节功能评分(HSS);记录3组并发症发生情况。结果C组术后24 h引流量(161.23±21.44)mL、围术期总失血量(701.45±45.68)mL低于A、B两组,差异有统计学意义(t=9.029、13.769、7.960、13.626,P<0.05);C组术后第3天Hb水平(96.63±6.45)g/L、Hct水平(38.27±5.53)%高于A、B两组,差异有统计学意义(t=4.088、5.813、5.110、7.629,P<0.05);A、B、C组术后并发静脉血栓概率分别为6.7%、6.7%、3.3%,对比差异无统计学意义(P>0.05);C组患者术后2周HSS评分(74.31±4.26)分及1个月HSS评分(76.62±4.28)分高于A、B两组,差异有统计学意义(t=8.154、5.201、8.052、4.436,P<0.05)。结论静脉滴注联合局部灌注氨甲环酸相对于单一途径给药在控制全膝关节置换术围术期失血方面效果显著,并促进患者早期膝关节功能的恢复,且安全性高。Objective To investigate the effectiveness of different ways of using tranexamic acid in controlling blood loss during perioperative period of total knee arthroplasty.Methods A total of 90 patients who were diagnosed with advanced degenerative knee osteoarthritis and required unilateral TKA surgery in the hospital from February 2018 to February 2020 were conveniently selected as the research subjects.They were randomly divided into groups,30 cases in each and tranexamic acid was administered in three different ways:topical,intravenous,and combined.The comprehensive performance of the three groups 24 hours after the operation was comprehensively observed and recorded.The preoperative and postoperative knee function scores(HSS)of the three groups were compared.The three groups of complications were recorded.Results The drainage volume at 24 h after operation in group C was(161.23±21.44)mL and the total perioperative blood loss(701.45±45.68)mL in group C was lower than that in group A and group B,and the differences were statistically significant(t=9.029,13.769,7.960,13.626,P<0.05).The Hb level(96.63±6.45)g/L and Hct level(38.27±5.53)%in group C were higher than those in group A and group B on the 3rd day after operation,and the difference was statistically significant(t=4.088,5.813,5.110,7.629,P<0.05).The probabilities of postoperative venous thrombosis in group A,group B,and group C were 6.7%,6.7%,and 3.3%,respectively,there was no statistically significant difference(P>0.05).The HSS score(74.31±4.26)points at 2 weeks and the HSS score at 1 month(76.62±4.28)points in group C were higher than those in group A and group B,and the differences were statistically significant(t=8.154,5.201,8.052,4.436,P<0.05).Conclusion Compared with single route administration,intravenous drip combined with local infusion of tranexamic acid is more effective in controlling perioperative blood loss in total knee arthroplasty,and promotes the recovery of early knee joint function in patients with high safety.

关 键 词：氨甲环酸 全膝关节置换术 围术期失血 膝关节功能 

分 类 号：R687[医药卫生—骨科学]