摘要
目的探讨初次接受单侧全膝关节置换术(TKA)患者围手术期采用不同方法使用止血带与氨甲环酸(TXA)不同的给药方式来降低围术期失血量的有效性及安全性。方法 将120例患者随机分为为4组:A组(29例)手术开始至骨水泥稳定期间使用止血带同时单独关节腔内灌注TXA,B组(31例)手术开始至骨水泥稳定期间使用止血带同时联合使用TXA,C组(28例)开始截骨至骨水泥稳定期间使用止血带同时单独关节腔内灌注TXA,D组(32例)开始截骨至骨水泥稳定期间使用止血带同时联合使用TXA。比较4组患者术中显性失血量、术后显性失血量、隐性失血量、总失血量、输血率及下肢深静脉血栓(DVT)的发生率。结果患者均获得4个月的随访。4组患者术中显性失血量比较差异均无统计学意义(P>0.05);术后显性失血量、隐性失血量、总失血量:D组<C组<B组<A组,差异均有统计学意义(P<0.05)。术后输血率D组低于A组、B组及C组,差异均有统计学意义(P<0.05)。4组术后均未发现症状性DVT和肺栓塞。结论限制性使用气囊止血带与联合使用TXA能有效减少TKA围术期失血量、降低输血率,且两者联合使用不增加DVT与肺栓塞的发生率。
Objective To explore the effectiveness and safety of different use methods of tourniquet and different administration ways of tranexamic acid (TXA) in decreasing the blood loss volume during the perioperative period for patients undergone primary unilateral total knee arthroplasty (TKA). Methods The 120 patients were randomly divided into 4 groups: Pneumatic tourniquet was used in group A (29 patients) and B (31 patients) from the beginning of operation to the stabilization of bone cement, while it was used in group C (28 patients) and D (32 patients) from the beginning of osteotomy to the stabilization of bone cement. Meanwhile, group A and C received TXA via only intraarticular injection, while group B and D received TXA via both intravenous drip before operation and intraarticular injection during operation. The intraoperative obvious blood loss, postoperative obvious and hidden blood loss, total blood loss, rate of blood transfusion, and incidence rate of deep venous thrombosis (DVT) were compared among the four groups. Results All patients were followed up for 4 months. There was no statistical significance among the four groups in the intraoperative obvious blood loss ( P >0.05). Postoperative obvious bleeding volume, hidden bleeding volume and total bleeding volume: group D<group C<group B<group A, and the differences were statistically significant ( P <0.05).The rate of blood transfusion in group D was lower than the other groups, and the differences were statistically significant ( P <0.05). Symptomtic DVT and pulmonary embolism were not found in all groups postoperatively. Conclusions The limited use of pneumatic tourniquet and the combined use of TXA in TKA can effectively reduce the perioperative blood loss and the rate of blood transfusion, and their combination does not increase DVT and pulmonary embolism risks.
作者
秦一可
陈清汉
任强
QIN Yi-ke;CHEN Qing-han;REN Qiang(Ward Ⅰ ,Dept of Orthopaedics,the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450003,China)
出处
《临床骨科杂志》
2019年第5期554-558,共5页
Journal of Clinical Orthopaedics
关键词
全膝关节置换术
气囊止血带
氨甲环酸
失血量
total knee arthroplasty
pneumatic tourniquet
tranexamic acid
blood loss volume
