摘要
背景:膝关节置换围术期出血较大,含有氨甲环酸的"鸡尾酒"有止血和镇痛的双重作用,然而如何联合静脉使用氨甲环酸进一步减少出血仍值得探讨。目的:在使用含氨甲环酸的"鸡尾酒"前提下,对比联合不同方式静脉使用氨甲环酸在全膝关节置换术中的止血效果和安全性。方法:回顾性分析2017年6月至2019年9月中山市人民医院骨一科收治行初次单侧全膝关节置换膝骨关节炎62例患者的病历资料,分成3组,其中A组26例术中关闭切口前局部给予含有氨甲环酸的"鸡尾酒";B组25例在A组基础上术前切皮前静脉点滴1.0 g氨甲环酸;C组11例在B组基础上于术后3 h再次静滴1次1.0 g氨甲环酸,对比分析3组患者显性、隐性及总失血量、术后血红蛋白最大丢失量、输血率、术后住院时间、术后并发症等。结果与结论:①在总失血量、隐性失血量、术中出血量、术后引流量、显性失血量、血红蛋白最大丢失量方面,B、C组均低于A组,差异有显著性意义(P<0.05);B组与C组间比较差异无显著性意义(P>0.05);②输血率和术后住院时间,3组间差异无显著性意义(P>0.05);③3组在伤口并发症、关节腔积液、肌间静脉血栓并发症发生率方面,差异均无显著性意义(P>0.05),且3组均未发现下肢深静脉血栓形成及肺动脉栓塞;④结果表明,在全膝关节置换手术切皮前静脉使用1次1.0 g氨甲环酸以及联合含0.5 g氨甲环酸的"鸡尾酒"具有明显的止血效果,但是术后3 h再次静脉使用1次1.0 g氨甲环酸未能进一步减少出血;而且前两者均不增加术后并发症,有一定的安全性。
BACKGROUND:The perioperative blood loss of total knee arthroplasty is large.The"cocktail"containing tranexamic acid has the dual function of hemostasis and analgesia.However,how to further reduce blood loss with intravenous tranexamic acid is still worth exploring.OBJECTIVE:To compare the hemostatic effect and safety of tranexamic acid combined with different intravenous applications of tranexamic acid in total knee arthroplasty under the premise of using"cocktail"containing tranexamic acid.METHODS:Data of 62 patients with osteoarthritis,who underwent primary unilateral total knee arthroplasty in the First Department of Orthopedics of Zhongshan People’s Hospital from June 2017 to September 2019,were retrospectively analyzed and divided into three groups.In the Group A,26 patients administrated"cocktail"containing tranexamic acid before closing the wound.In the Group B,25 patients administrated intravenously 1.0 g tranexamic acid before cutting skin on the basis of group A.In the Group C,11 patients administrated intravenously 1.0 g tranexamic acid on the basis of group B 3 hours postoperatively.Dominant,hidden,and total blood loss,postoperative hemoglobin biggest loss,blood transfusion rate,postoperative hospital stay and postoperative complications were compared and analyzed among three groups.RESULTS AND CONCLUSION:(1)In terms of blood loss(including total,hidden,intraoperative,postoperative and dominant)and the maximum loss of hemoglobin,both groups B and C were lower than group A,with statistically significant differences(P<0.05);there were no significant differences between group B and group C(P>0.05).(2)There were no statistically significant differences in blood transfusion rate and postoperative hospital stay among three groups(P>0.05).(3)There were no statistically significant differences among the three groups in the incidence of wound complications,articular effusion,and complications of intermuscular vein thrombosis(P>0.05).No lower limb deep vein thrombosis or pulmonary embolism was found in the th
作者
王金军
邓增发
刘康
何智勇
余新平
梁建基
李晨
郭洲洋
Wang Jinjun;Deng Zengfa;Liu Kang;He Zhiyong;Yu Xinping;Liang Jianji;Li Chen;Guo Zhouyang(Zhongshan People’s Hospital,Zhongshan 528403,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第9期1356-1361,共6页
Chinese Journal of Tissue Engineering Research
关键词
骨
关节
全膝关节置换
氨甲环酸
静脉
局部
出血量
隐性失血量
bone
joint
total knee arthroplasty
tranexamic acid
vein
topical
blood loss
hidden blood loss
