摘要
目的 :探讨术前静脉滴注氨甲环酸联合术中关节腔内注射给药对人工全膝关节置换术(TKA)患者隐性失血、术后引流量及关节功能的影响。方法 :选取2015年1月—2017年5月我院收治的需行TKA术的终末期膝关节骨性关节炎患者86例,按照随机数字表法分为三组,A组在术前30 min给予氨甲环酸15 mg/kg,ivgtt;B组在缝合完成,松止血带前,采用20 mL注射器向关节囊内注射氨甲环酸1 g;C组采用A组联合B组的给药方法。比较三组隐性失血量、总失血量、术后24 h引流量,术前、术后4 h D-二聚体水平及术后7 d、3个月膝关节活动度(ROM)和美国膝关节协会功能评分(KSS)。结果 :B、C组隐性失血量、总失血量、术后24 h引流量均明显低于A组,差异有统计学意义(P <0.05);C组隐性失血量、术后24 h引流量明显低于B组,差异有统计学意义(P <0.05);术后4 h三组D-二聚体水平较术前明显升高,差异有统计学意义(P <0.05);三组术后7 d、术后3个月膝ROM及KSS评分显著高于术前,且B、C组高于A组,差异有统计学意义(P <0.05)。结论 :术前静脉滴注与术中关节腔内注射氨甲环酸能够明显降低终末期膝关节骨性关节炎患者TKA术后隐性失血量及术后引流量,有效改善膝关节功能。
Objective: To investigate the effect of preoperative intravenous injection of tranexamic acid and intraoperative intra-articular administration on hidden blood loss, postoperative drainage volume and joint function in patients undergoing total knee arthroplasty (TKA). Methods: 86 patients with end-stage knee osteoarthritis requiring TKA admitted to our hospital from January 2015 to May 2017 were selected and randomly divided into three groups. The patients in the group A were given tranexamic acid (15 mg/kg, ivgtt) at 30 min before surgery;the patients in the group B were given injection of tranexamic acid 1 g into articular capsule with 20 mL syringe after stitching and before loosening the tourniquet;the patients in the group C were treated by combined administration method of the groups A and B. The hidden blood loss volume, total blood loss volume, drainage volume at 24 h after surgery, D-dimer level before surgery and at 4 h after surgery, range of motion (ROM) of knee and American knee society knee score (KSS) 7 days, 3 months after surgery were compared between the three groups. Results: The hidden blood loss volume, total blood loss volume and drainage volume at 24 h after surgery in the groups B and C were significantly lower than those in the group A (P<0.05). The hidden blood loss volume and drainage volume at 24 h after surgery in the group C were significantly lower than those in the group B (P<0.05). The levels of D-dimer in the three groups at 4 h after surgery were significantly higher than those before surgery (P<0.05). The ROM of knee and KSS score in the three groups 7 days, 3 months after surgery were significantly higher than those before surgery, and they in the groups B and C were significantly higher than those in the group A (P<0.05). Conclusion: Preoperative intravenous drip and intraoperative intra-articular injection of tranexamic acid can significantly reduce hidden blood loss volume and postoperative drainage volume after end-stage KKA in patients with knee osteoarthritis, and effect
作者
郑云龙
付新生
张其川
崔银江
Zheng Yun-long;Fu Xin-sheng;Zhang Qi-chuan;Cui Yin-jian(Department of Joint Surgery,Xinxiang Central Hospital,Henan Xinxiang 453000,China)
出处
《中国执业药师》
CAS
2018年第11期56-59,共4页
China Licensed Pharmacist
关键词
人工全膝关节置换术
氨甲环酸
隐性失血
术后引流量
功能恢复
Total Knee Arthroplasty
Tranexamic Acid
Hidden Blood Loss
Postoperative Drainage Volume
Functional Recovery
