术中不同方式应用氨甲环酸对单侧全膝关节置换术围术期止血效果和术后疼痛的影响  

Effects of Intraoperative Tranexamic Acid on Perioperative Hemostasis and Postoperative Pain of Unilateral Total Knee Arthroplasty by Different Modes of Application

作　　者：张磊[1] 姜雪峰[1] 孙惠清[1] 倪卓民[1] 徐军[1] ZHANG Lei;JIANG Xuefeng;SUN Huiqing;NI Zhuomin;XU Jun(Department of Orthopedics,Jiangyin People's Hospital,Jiangyin,Jiangsu Province,214400 China)

机构地区：[1]江阴市人民医院骨科,江苏江阴214400

出　　处：《中外医疗》2022年第34期59-62,67,共5页China & Foreign Medical Treatment

摘　　要：目的探讨术中不同方式应用氨甲环酸(tranexamic acid,TXA)对单侧全膝关节置换术(total knee arthroplasty,TKA)围术期止血效果和术后疼痛的影响。方法回顾性分析2019年3月-2021年3月于江阴市人民医院进行TKA治疗的80例患者的临床资料,根据术中TXA使用方法不同分为3组,对照一组(n=25)行静脉滴注,对照二组(n=27)行关节腔内注射,观察组(n=28)采用关节内注射联合静脉滴注。比较3组止血效果、血红蛋白(Hb)水平、疼痛程度及安全性。结果3组术中失血量、隐性失血量、总失血量相比,观察组[(38.23±6.45)、(244.39±33.58)、(542.35±124.29)mL]均低于其他两组,对照二组[(51.44±10.63)、(279.58±35.26)、(662.87±135.47)mL],均低于对照一组[(55.23±13.21)、(296.45±38.19)、(759.68±142.54)mL],差异有统计学意义(F=20.064、14.892、17.542,P<0.05)。3组术前Hb水平、疼痛评分比较,差异无统计学意义(P>0.05);3组术后不同时间Hb水平相比,观察组最高,对照一组高于对照二组;3组术后1 d疼痛评分相比,观察组最低,对照二组低于对照一组,差异有统计学意义(F=39.952、32.101、39.928、13.367,P<0.05)。结论TKA术中关节内注射联合静脉滴注TXA止血效果更佳,利于减少失血量,控制Hb水平,减轻患者术后疼痛,且不会形成下肢静脉血栓。Objective To investigate the effects of intraoperative application of tranexamic acid(TXA)on perioperative hemostasis and postoperative pain in unilateral total knee arthroplasty(TKA)by different modes of application.Methods The clinical data of 80 patients treated with TKA in Jiangyin People's Hospital from March 2019 to March 2021 were retrospectively analyzed.They were divided into three groups according to the different methods of using TXA during operation.The control group 1(n=25)received intravenous drip,the control group 2(n=27)received intra-articular injection,and the observation group(n=28)received intra-articular injection combined with intravenous drip.The hemostatic effect,hemoglobin(Hb)level,pain degree and safety of the three groups were compared.Results Compared with the three groups of intraoperative blood loss,occult blood loss,and total blood loss,the observation group[(38.23±6.45)mL,(244.39±33.58)mL,and(542.35±124.29)mL]were lower than the other two groups,the control group 2[(51.44±10.63)mL,(279.58±35.26)mL,(662.87±135.47)mL]was lower than the control group 1[(55.23±13.21)mL,(296.45±38.19)mL,and(759.68±142.54)mL],the difference was statistically significant(F=20.064,14.892,17.542,P<0.001).There was no statistically significant difference in preoperative Hb levels and pain scores among the three groups(P>0.05).Compared with the three groups at different times after surgery,the observation group had the highest Hb level,with the control group 1 being higher than the control group 2;the observation group had the lowest pain score on the first day after surgery,and the control group 2 was lower than the control group 1,the difference was statistically significant(F=39.952,32.101,39.928,13.367,P<0.001).Conclusion Intraarticular injection combined with intravenous TXA drip during TKA has better hemostatic effect,facilitates the reduction of blood loss,controls the Hb level,reduces postoperative pain in patients,and does not form lower limb venous thrombosis.

关 键 词：单侧全膝关节置换术 氨甲环酸 止血效果 术后疼痛 

分 类 号：R5[医药卫生—内科学]