摘要
背景:人工膝关节置换是治疗终末期膝关节骨性关节炎的有效方法,可以明显缓解疼痛,改善功能。但术后大量失血是其较为严重的并发症之一,如何减少术后失血一直困扰着关节外科医生。目的:探讨不同剂量氨甲环酸关节内局部应用结合不放置引流减少全膝关节置换后失血的效果。方法:选择行全膝关节置换的150例骨关节炎患者,随机分成3组,每组50例。A组为关节腔注射氨甲环酸2 g加生理盐水稀释至50 m L;B组为关节腔注射氨甲环酸1 g加生理盐水稀释至50 m L;C组为对照组,关节内注射生理盐水50 m L,均不放置引流。记录和比较3组患者术后不同时间点的血红蛋白值、输血人数、术中失血量、术后显性失血量、术后隐性失血量、术后总失血量和术后3 h相关凝血指标,观察有无切口感染、下肢深静脉血栓形成等并发症发生。结果与结论:(1)3组患者相比,术后第1,3,5天血红蛋白值差异均有显著性意义(F=7.218-7.516,P=0.000);(2)术后A,B,C组患者输血人数分别为2,5和9例,差异亦有显著性意义(χ~2=5.753,P=0.000);(3)3组患者之间术中失血量差异无显著性意义(F=1.206,P=5.283),术后显性失血量比较差异有显著性意义(F=14.389,P=0.000),术后隐性失血量差异有显著性意义(F=7.158,P=0.009),术后总失血量差异亦有显著性意义(F=6.752,P=0.012),且止血效果与氨甲环酸呈剂量依赖效应;(4)3组患者术后3 h凝血指标比较差异无显著性意义(P>0.05);(5)术后1周复查下肢血管彩超,未见明显下肢深静脉血栓形成;术后3个月内观察3组患者未见症状性深静脉血栓和肺栓塞发生;(6)综上,全膝关节置换术中关节内注射氨甲环酸且不放置引流,可以有效减少围手术期失血和输血,不增加并发症,且止血效果与氨甲环酸呈剂量依赖关系。
BACKGROUND： Total knee arthroplasty （TKA） is an effective method for the end-stage knee osteoarthritis, which can obviously relieve pain and improve function. But a large amount of postoperative blood loss is a serious complication, how to reduce postoperative blood loss is still a difficulty. OBJECTIVE： To explore the efficacy of local application of different doses of tranexamic acid without drainage on the METHODS： 150 patients with osteoarthritis who underwent TKA were randomly divided into three groups （n=50 per group）. Group A received the intra-articular injection of tranexamic acid （2 g） plus 50 mL of normal saline; group B received the intra-articular injection of tranexamic acid （1 g） 50 mL of normal saline; group C received the intra-articular injection of 50 mL of normal saline. The drainage tube was not used in all patients. The number of hemoglobin, the number of patients undergoing blood transfusion, intraoperative blood loss, external blood loss, hidden blood loss, total blood loss and postoperative 3 hour-related blood coagulation indexes were recorded and compared among groups. Additionally, the incision infection and deep vein thrombosis were observed. RESULTS AND CONCLUSION： （1） The difference of hemoglobin among groups was significant （F=7.218-7.516, P=0.000）.（2）The number of blood transfusion in the groups A,B and C was 2,5 and 9,respectively,which had significant differences （χ2=25.753, P=0.000）. （3） The intraoperative blood loss had no significant difference among groups （F=1.206, P=5.283）. The difference in the postoperative external blood loss, postoperative hidden blood loss and total postoperative blood loss among groups was significant （F=14.389, P=0.000; F=7.158, P=0.009; F=6.752, P=0.012）. Moreover, the hemostatic effect was in a dose-dependent manner. （4） There were no significant differences in the postoperative 3-hour-related blood coagulation indexes among groups （P 〉 0.05）. （5） There was no deep vein thrombosis
出处
《中国组织工程研究》
CAS
北大核心
2017年第35期5583-5588,共6页
Chinese Journal of Tissue Engineering Research
关键词
骨科植入物
人工假体
氨甲环酸
引流
全膝关节置换
失血
Arthroplasty, Replacement, Knee
Tranexamic Acid
Drainage
Blood Loss, Surgical
TissueEngineering
