摘要
目的观察四味补血汤口服联合氨甲环酸局部应用对全膝关节置换术(total knee arthroplasty,TKA)后减少隐性失血和改善贫血的临床疗效。方法选取2018年1月-2019年5月在本院接受初次单侧全膝置换手术治疗的90例患者为研究对象,将患者随机分为Ⅰ、Ⅱ、Ⅲ三组,每组各30例。Ⅰ组切口正常关闭,留置负压引流管;Ⅱ组和Ⅲ组患者则在切口关闭后向关节腔注入溶有1.5 g氨甲环酸(tranexamic acid,TXA)的0.9%氯化钠50 ml,并于术后夹闭引流管4小时、Ⅲ组患者术后服用四味补血汤一周。比较三组患者手术时间、术后显性失血量、隐性失血量,术前1 d、术后3 d、术后7 d的血红蛋白(Hb)、红细胞比容(Hct)和术后并发症情况。采用纽约特种医院评价系统(hospital for special surgery,HSS)对术前和术后1月膝关节功能评分。结果 (1)三组手术时间比较,组间比较无统计学差异(P>0.05));Ⅰ组术后显性失血量、隐性失血量明显高于Ⅱ、Ⅲ组,具有统计学差异(P<0.05),Ⅱ、Ⅲ组之间比较没有明显差异(P>0.05);术后3 d和术后7 d Hb、Hct的3组整体比较有明显差异(P<0.05)、术后7 dⅢ组的Hb,Hct高于Ⅱ组且有统计学意义(P<0.05)。(2)所有患者均获得随访。三组患者术后1月VAS评分较术前明显减低,组间差异无统计学意义(P>0.05);术后1月HSS评分三组均较术前明显提高,Ⅱ、Ⅲ组评分明显高于Ⅰ组(P<0.05),Ⅲ组评分高于Ⅱ组且有统计学意义(P<0.05))。(3)术后Ⅰ组出现1例切口浅表感染、4例输血、深静脉血栓1例,Ⅱ组出现1例切口浅表感染、1例输血,Ⅲ组出现1例输血。三组术后并发症发生率比较无统计学意义(P<0.05)。结论全膝关节置换术中关节腔局部应用氨甲环酸联合应用四味补血汤既可以减少术后隐性失血量又可以明显改善术后贫血状态,促进膝关节功能的恢复。
Objective To observe the clinical effect of Siwei Buxue decoction combined with local application of tranexamic acid on reducing hidden blood loss and improving anemia after total knee arthroplasty.Methods From January 2018 to May 2019,90 patients who received primary unilateral total knee replacement surgery in our hospital were selected as the research objects. All the patients were randomly divided into three groups:Ⅰ,Ⅱ and Ⅲ with 30 cases in each group.The incision of group I was normally closed and negative pressure drainage tube was retained,patients in groupⅡand groupⅢwere received 50 mL of 0.9% sodium chloride dissolved with 1.5 g tranexamic acid injection and the drainage tube was clamped for 4 hours after operation.The patients of group III took Siwei Buxue decoction for one week after operation. The operation time,postoperativedominant blood loss and hidden blood loss of the three groups were compared. Postoperative complications,hemoglobin( Hb) and red blood cell volume( Hct) on the 1 st( 1 d) day before operation,3 rd( 3 d) and 7 th( 7 d) day after operation were measured and compared respectively.The knee joint function was scored by using the New York hospital for special surgery( HSS) before operation and 1 month after operation.Results In terms of operation time,there was no statistical difference among the three groups( P> 0.05). The amount of dominant blood loss and hidden blood loss in group I was significantly higher than that in groupⅡ and groupⅢ( P<0.05),but there was no significant difference between group Ⅱ and group Ⅲ( P>0.05). There were significant differences among threegroupsin Hb and Hcton the 3 r d and 7 t h day after operation( P< 0.05),and the concentration of Hb and Hct on 7 t h day after operation in group Ⅲ were significantly higher than those in group Ⅱ( P<0.05). All patients were followed up. The VAS scores of the three groups were significantly decreased one month after operation,however,there was no significant difference among the three groups( P> 0.
作者
顾荣胜
田敏
孟庆国
陆华
祁兆建
陈大志
韩廷成
范广峰
GU Rong-sheng(Orthopedics section 1,traditional Chinese medical hospital of Yancheng City,Yancheng,Jiangsu,224001,China)
出处
《齐齐哈尔医学院学报》
2020年第2期154-157,共4页
Journal of Qiqihar Medical University
关键词
全膝关节置换术
氨甲环酸
关节腔注射
失血性贫血
补血汤
Total knee arthroplasty
Tranexamic acid
Intra-articular injection
Hemorrhagic anemia
Blood enriching decoction
