术中关节腔注射氨甲环酸与肾上腺素对老年全膝关节置换术后出血的影响

目的观察术中关节腔内注射氨甲环酸(tranexamic acid,TXA)与肾上腺素对老年全膝关节置换术(total knee arthroplasty,TKA)后出血的影响。方法选择2015年1月—2016年5月霸州市第二医院行初次单侧TKA手术的老年创伤性膝关节炎患者168例为研究对象,采用随机、双盲的方法将符合纳入和排除标准的168例患者分为观察组、对照A组及对照B组,每组56例。观察组在松止血带前关节腔内注射1g TXA和0.25mg肾上腺素,对照A组在松止血带前关节腔内注射1g TXA,对照B组关节腔内注射生理盐水50m L。观察比较3组患者术后3d血红蛋白(Hb)和红细胞压积(Hct)下降值,围术期总出血量、术后引流量及隐性出血量。记录和比较3组患者异体输血率、术后3个月内下肢静脉血栓(DVT),术后3d大腿、小腿周径变化率及皮下瘀斑面积1%发生率。结果观察组术后3d Hb和Hct下降值以及围术期总出血量、术后引流量、隐性出血量均明显低于对照A组及对照B组,差异有统计学意义(P0.05);对照A组术后3d Hb和Hct下降值以及围术期总出血量、术后引流量、隐性出血量均明显低于对照B组,差异有统计学意义(P0.05)。观察组皮下瘀斑面积1%发生率、术后3d大腿、小腿周径变化率低于对照A组及对照B组,差异有统计学意义(P0.05)。3组患者术后超声检查和随访未发现症状性DVT发生。结论关节腔内注射TXA与肾上腺素可有效减少TKA术后出血,且安全性高,具有一定的推广应用价值。

Efficacy of intra-articular injection of tranexamic acid plus epinephrine on postoperative blood loss in elderly patients with total knee arthroplasty

Objective To observe the efficacy of intra-articular injection of tranexamic acid plus epineph-rine on postoperative blood loss in elderly patients with total knee arthroplasty .Methods Totally 168 elderly trau-matic knee arthritis patients with unilateral TKA met inclusion and exclusion criteria from the Second Hospital of Ba -zhou City between Jan .2015 and May 2016 were enrolled in this study ,and assigned randomly to observation group , control group A ,and control group B ,with 56 cases in each group .The patients in observation group were injected intraarticularly 1g TXA plus 0.25 mg epinephrine before release of tourniquet ,the patients in control group A and control group B were intravenous injected 1g TXA and 50 mL physiological saline ,respectively before release of tour-niquet.The drop-out values of Hb and Hct 3d after operation,total blood loss,total postoperative drainage volume and hidden blood loss were observed and compared .The rates of allogeneic blood transfusion ,incidence of deep vein thrombosis (DVT) within 3 months after surgery,postoperative 3d change rates of thigh and calf girths ,incidence of subcutaneous ecchymosis area >1%were recorded and compared .Results The drop-out values of Hb and Hct 3d after operation,total blood loss,total postoperative drainage volume and hidden blood loss in the observation group were significantly lower than those in control group A and control group B ,and the differences were statistically sig-nificant(P<0.05).The drop-out values of Hb and Hct 3d after operation,total blood loss,total postoperative drain-age volume and hidden blood loss in control group A were significantly lower than those in control group B ,and the differences were statistically significant ( P<0.05) .The incidence of subcutaneous ecchymosis area >1%,postoper-ative 3 d change rates of thigh and calf girths in the observation group were significantly lower than those in control group A and control group B,and the differences were statistically significant (P<0.05).No symptomatic DVT was found by ultrasound examination and telephone follow-up within 3 months after surgery in any group .Conclusion TXA plus epinephrine by articular cavity injection is effective and safe on reducing postoperative blood loss after uni -lateral TKA,and has a certain application value .