局部应用低温氨甲环酸及改变体位对全膝关节置换术后失血量的影响

目的探讨全膝关节置换术后关节腔内局部灌注低温氨甲环酸(TXA)(4℃)联合术后6 h屈髋45°、屈膝60°体位对术后失血量的影响和安全性。方法南京医科大学附属逸夫医院骨科自2016年10月至2018年4月共实施单侧初次人工全膝关节置换术45例,患者随机分为三组,每组15例。术毕通过引流管向关节腔内分别注入A组:低温氨甲环酸注射液50 mL (30 mg/mL,4℃),配合术后屈髋45°、屈膝60°体位6小时;B组:低温氨甲环酸注射液50 mL (30 mg/mL,4℃);C组:常温氨甲环酸注射液50 mL (30 mg/mL)。术后引流管夹闭6 h后开放行持续负压引流,术后24 h拔除引流管,记录各组患者年龄、身高、体重、术中出血量、术后引流量、术前红细胞比容及术后第3天红细胞比容,根据Gross公式计算失血量,对以上三组失血量进行相关分析。结果术后24 h,三组患者术后引流量分别为A组(159.47±9.11)mL,B组(237.80±7.42)mL,C组(296.67±27.09)mL,A组术后平均引流量明显少于B组和C组(P<0.05)术后的引流量;术后第3天的隐形失血量分别为A组(261.73±12.39)mL, B组(305.47±18.04)mL,C组(339.67±11.57)mL, A组术后隐性失血量明显低于B组和C组(P<0.05)。三组不良反应发生情况比较,差异无统计学意义(P>0.05)。结论和常温TXA注射液相比,低温TAX局部注射可减少TKA术后失血;低温TXA局部应用联合术后6 h屈髋45°、屈膝60°体位是一种更安全有效减少TKA术后失血的方法。

Effects of topical application of low temperature tranexamic acid and changing position on blood loss after total knee arthroplasty

Objective To investigate the effect and safety of local perfusion of hypothermic methicinic acid(4℃)combined with 6 hours of hip flexion 45 degrees,knee flexion 60 degrees position on blood loss after total knee arthroplasty(TKA).Methods 45 cases of primary total knee arthroplasty were performed from October 2016 to April 2018 in department of orthopedics,the Affiliated Sir Run Run Hospital of Nanjing Medical University.The patients were divided into 3 groups randomly,with 15 cases in each group.The A group was injected into the articular cavity through the drainage tube at the end of the operation:low temperature Tranexamic Acid Injection 50 mL(30 mg/mL,4℃),6 hours of hip flexion45 degrees,knee flexion 60 degrees position after operation;group B:low temperature Tranexamic Acid Injection 50 mL(30 mg/mL,4℃);group C:normal temperature tranexamic acid injection 50 mL(30 mg/mL).The drainage tube was closed for 6 hours and then was opened by continuous negative pressure drainage.The age,height,weight,intraoperative bleeding,postoperative bleeding,erythrocyte specific volume before operation and the third day after the operation were recorded,and the amount of blood loss was calculated according to the Gross formula,and the blood loss in the above 3 groups was analyzed.Results After operation 24 h,the postoperative drainage volume of the 3 groups were A group(159.47±9.11)mL,B group(237.80±7.42)mL,C group(296.67±27.09)mL,and the average drainage volume of group A was significantly less than that of group B and group C(P<0.05)after operation.The amount of hidden blood loss at third day after operation was(261.73±12.39)mL in group A,(305.47±18.04)mL in group B and(339.67±11.57)mL in group C.The hidden blood loss in group A was significantly lower than that in group B and group C(P<0.05).There was no significant difference in the incidence of adverse reactions between the three groups(P>0.05).Conclusion Compared with normal temperature TXA injection,hypothermia TAX injection can reduce postoperative blood loss after TKA.Local application of low temperature TXA combined with 6 hours of hip flexion 45 degrees,knee flexion 60 degrees position after operation is a safer and more effective way to reduce blood loss after TKA.