摘要
目的探讨在加速康复外科(enhanced recovery after surgery,ERAS)理念下鸡尾酒联合氨甲环酸(tranexamic acid,TXA)对全膝关节置换术(total knee arthroplasty,TKA)后的疗效。方法回顾性分析2020年9月~2022年7月蚌埠医学院第二附属医院收治的70例行单侧TKA治疗的膝骨关节炎患者,根据治疗方法不同,将其分为试验组和对照组,每组35例。在ERAS理念指导下,试验组于术中关节内注射鸡尾酒和TXA混合液,对照组于术中关节内注射鸡尾酒和0.9%氧化钠溶液混合液。比较两组术后引流量、术后3天血红蛋白(hemoglobin,Hb)下降值和总失血量、输血率、首次下床活动时间、住院时间、术后不同时间点的疼痛视觉模拟评分(visual analogue scale,VAS评分)、膝关节活动度(knee range of motion,ROM)以及HSS评分、切口延迟愈合、感染及深静脉血栓形成发生率。结果试验组的术后引流量、术后3天Hb下降值和总失血量以及输血率均低于对照组,差异有统计学意义(P<0.05);首次下床活动时间和住院时间均明显低于对照组,差异有统计学意义(P<0.05);两组术后1、2、3、7、14天疼痛VAS评分比较,差异无统计学意义(P>0.05);两组术后7、14天ROM以及术后4、12周HSS评分的变化趋势比较,差异无统计学意义(P>0.05)。结论在ERAS理念下,TKA中关节内注射鸡尾酒联合TXA,可有效降低术后失血量,改善术后疼痛,减少围术期发生风险,促进术后早期更好的康复,临床疗效显著。
Objective To investigate the curative effect of cocktail combined with tranexamic acid(TXA)on total knee arthroplasty(TKA)under the concept of enhanced recovery after surgery(ERAS).Methods Seventy patients with knee osteoarthritis who received unilateral TKA treatment admitted to the Second Affiliated Hospital of Bengbu Medical College from September 2020 to July 2022 were retrospectively analyzed.According to different treatment methods,they were divided into experimental group and control group,with 35 cases in each group.Under the guidance of ERAS concept,the experimental group received injected intraarticular mixture of cocktail and TXA during the operation,while the control group received injected intraarticular mixture of cocktail and normal saline.Postoperative drainage volume,hemoglobin(Hb)decline and total blood loss at 3 days after operation,blood transfusion rate,first ambulation time,length of hospital stay,postoperative pain visual analogue scale(VAS)、knee range of motion(ROM)and HSS score at different time points after operation,delayed wound healing,wound infection and incidence of deep vein thrombosis were compared between the two groups.Results The postoperative drainage volume,decline of Hb and total blood loss at 3 days after operation,blood transfusion rate in the experimental group were less than those of the control group,the differences were statistically significant(P<0.05).The first ambulation time and length of hospital stay in the experimental group were significantly lower than those of the control group,the difference were statistically significant(P<0.05).There were no significant differences in pain VAS score at 1 day,2 days,3 days,7 days,14 days after operation between two groups(P>0.05).There were no significant differences in ROM at 7 days,14 days after operation and HSS score at 4 weeks,12 weeks after operation between two groups(P>0.05).Conclusion Under the concept of ERAS,intraarticular injection of cocktail combined with TXA in TKA can effectively reduce postoperative blood
作者
胡腾飞
袁伶俐
韩俊柱
张仲传
郭成
朱勋兵
HU Tengfei;YUAN Lingli;HAN Junzhu(Department of Orthopaedics,The Second Affiliated Hospital of Bengbu Medical College,Anhui 233000,China)
出处
《医学研究杂志》
2023年第12期115-119,127,共6页
Journal of Medical Research
基金
安徽省高校自然科学研究重点项目(KJ2021A0744)。
关键词
全膝关节置换术
鸡尾酒
氨甲环酸
加速康复外科
Total knee arthroplasty
Cocktail
Tranexamic acid
Enhanced recovery after surgery
