摘要
目的:探讨全膝关节置换术中两次使用氨甲环酸联合术后患肢屈髋屈膝位对减少其围手术期失血量的有效性和安全性。方法:自2015年1月至2018年1月,选择因膝骨关节炎行单侧全膝关节置换患者90例,男33例,女57例;年龄61~85(72.3±6.9)岁。采用随机数字表法分为3组,每组30例。A组,男11例,女19例;年龄61~84(71.60±6.04)岁;BMI(26.04±1.95)kg/m^2;血红蛋白(128.57±5.98)g/L;上止血带前静脉滴注7.5 mg/kg氨甲环酸,关闭切口后松止血带前再次静脉滴注7.5 mg/kg氨甲环酸,同时配合术后患肢屈髋30°~45°,屈膝60°~70°。B组,男10例,女20例;年龄61~85(72.03±7.47)岁;BMI(25.92±1.70)kg/m^2;血红蛋白(127.58±4.37)g/L;松止血带前静脉滴注15 mg/kg氨甲环酸。C组,男12例,女18例;年龄62~85(73.23±7.36)岁;BMI(26.07±1.49)kg/m^2;血红蛋白(128.31±5.61)g/L;松止血带前静脉滴注等量生理盐水。记录3组患者术中出血量、术后引流量、隐性失血量、总失血量、输血例数、活化的部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶原国际标准化比值(PT-INR)及D-二聚体(D-D)等指标,并观察术后有无下肢深静脉血栓和肺栓塞。结果:90例患者均无切口感染发生,全部患者获得随访,时间4~8个月,平均6个月,均无肺栓塞情况发生。3组患者术中出血量比较差异无统计学意义,而术后引流量、隐性出血量、总失血量等比较差异有统计学意义;3组术后输血例数分别为2、8和16例,差异有统计学意义(χ^2=16.01,P<0.001)。术后3组患者APTT、PT、PT-INR及D-D比较差异无统计学意义(P>0.05);术后3组患者出现下肢深静脉血栓例数比较差异无统计学意义。结论:上止血带前及关闭切口后松止血带前2次使用氨甲环酸联合术后患肢屈髋屈膝体位的方法,可有效减少全膝关节置换术后引流量、隐性失血量及总失血量,减少患者术后输血,且未增加下肢深静脉血栓和肺栓塞的风险。
Objective:To explore clinical efficacy and safety of application of tranexamic acid for two times combined with postoperative hip and knee on flexion position for reducing blood loss during total knee arthroplasty.Methods:From January 2015 to January 2018,90 patients with knee osteoarthritis underwent unilateral total knee arthroplasty,including 33 males and 57 females,aged from 61 to 85 years old with an average of(72.3±6.9)years old.The patients were randomly divided into three groups according to random number table,30 patients in each group.In group A,there were 11 males and 9 females,aged from 61 to 84 years old with an average of(71.60±6.04)years old,body mass index was(26.04±1.95)kg/m^2,hemoglobin was(128.57±5.98)g/L,treated by 7.5 mg/kg tranexamic acid was injected intravenously before upper tourniquet,and 7.5 mg/kg tranexamic acid after closure of incision and before loosening tourniquet,meanwhile combined with flexion position of hip for 30°to 45°and flexion position of knee for 60°for 70°.In group B,there were 10 males and 20 females aged from 61 to 85 years old with an average of(72.04±7.47)years,body mass index was(25.92±1.70)kg/m^2,hemoglobin was(127.58±4.37)g/L,treated by 15 mg/kg tranexamic acid injected intravenously before loosening tourniquet.In group C,there were 12 males and 18 females aged from 62 to 85 years old with an average of(73.23±7.36)years,body mass index was(26.07±1.49)kg/m^2,hemoglobin was(128.31±5.61)g/L,treated with the same amount of normal saline before loosening tourniquet.Intraoperative bleeding volume,postoperative drainage volume,recessive blood loss,total blood loss volume,blood transfusion cases,activated partial thromboplastin time(APTT),prothrombin time(PT),prothrombin international standardized ratio(PT-INR)and indexes of D-dimer(D-D)were compared among three groups,as well as postoperative deep venous thrombosis and pulmonary embolism were observed among three groups.Results:No incision infection occurred in all 90 patients,and all patients were followed up from 4 to 8 months with an average of 6 months without pulmonary embolism occurred.There was no statistical difference in itraoperative bleeding volume among three groups(F=0.299,P=0.742),while there were significant differences in postoperative drainage volume,recessive blood loss,and total blood loss among three groups.The number of blood transfusion were as following,2 cases in group A,8 cases in group B,and 16 cases in group C,there were statistically significant differences among three groups(χ2=16.01,P<0.001).There were no differences in APTT,PT,PT-INR and D-D after operation among three groups(P>0.05),and no difference in occurrence of lower limb vein thrombosis after operation.Conclusion:The method of using tranexamic acid before upper tourniquet,after closure of incision and before loosening tourniquet-combined with the flexion position of hip and knee could effectively reduce postoperative drainage volume,recessive bleeding,total blood loss and blood transfusion cases after total knee arthroplasty,while it does not increase risk of deep vein thrombosis and pulmonary embolism.
作者
潘定权
陈玲丽
孙飚
俞喆
葛剑斌
缪美芬
PAN Ding-quan;CHEN Ling-li;SUN Biao;YU Zhe;GE Jian-bin;MIAO Mei-fen(Department of Orthopaedics,Dongyang Traditional Chinese Medicine Hospital,Dongyang 322100,Zhejiang,China)
出处
《中国骨伤》
CAS
CSCD
2019年第8期759-764,共6页
China Journal of Orthopaedics and Traumatology
基金
2015年度金华市科学技术研究计划项目(编号:2015-3-092)~~
关键词
关节成形术
置换
膝
失血
手术
氨甲环酸
体位
Arthroplasty,replacement,knee
Blood loss,surgical
Tranexamic acid
Posture
