氨甲环酸静脉滴注联合关节腔注射对初次全膝关节置换患者术后出血量的影响

目的：探讨氨甲环酸静脉滴注联合关节腔注射对初次行全膝关节置换患者术后出血量的影响。方法以2015年1月至2015年5月收治的45例重度膝骨关节炎行初次全膝关节置换的患者为研究对象，随机分为氨甲环酸组（23例）与对照组（22例）。氨甲环酸组术中松止血带前30 min 静脉应用氨甲环酸10 mg/ kg，并于手术结束后经引流管向关节腔注射1.0 g 氨甲环酸，夹闭引流管4 h，弹力绷带包扎。对照组的处理为给予相应量的生理盐水。观察两组患者术后24 h、48 h 引流量并于术后第3天复查血常规。结果氨甲环酸组术后切口引流量平均约220 mL，与对照组450 mL 相比，差异有统计学意义（P <0.05）。术后第3天复查血红蛋白的降低程度，氨甲环酸组降低约12.9 g/ L，明显小于对照组23.5 g/ L，且差异有统计学意义（P <0.05）。结论氨甲环酸静脉滴注联合关节腔注射可以明显降低初次全膝关节置换患者术后出血量。

Effects of intravenous and intra-articular tranexamic acid on postoperative blood loss of primary total knee arthroplasty

Objective To investigate the effect of intravenous and intra-articular tranexamic acid on postoperative blood loss of pri-mary total knee arthroplasty(TKA). Methods From Jan 2015 to May 2015,45 patients who received primary TKA due to severe knee os-teoarthritis were randomly allocated to tranexamic acid(TA)group(n = 23)and control group(n = 22). Patients in the TA group received intravenous tranexamic acid 10 mg/ kg at 30 min before tourniquet release and 1. 0 g tranexamic acid intra-articular injection through the drain tube rightly after wound closure,followed by drain tube clip for 4 hours and pressured elastic bandage. The corresponding amount of saline was administered in the control group. The volume of drainage was recorded at 24 and 48 hours after operation,and haemoglobin level was in-spected again at 3 days after operation. Results Compared with 450 ml drainage fluid in the control group,the mean volume of drainage postoperatively obtained from the TA group was 220 ml,with statistically significant difference(P < 0. 05). And the drop in haemoglobin lev-el at 3 days after operation was about 12. 9 g/ L in the TA group,which was statistically significant less than the drop of 23. 5 g/ L in the con-trol group(P < 0. 05). Conclusion Application of intravenous and intra - articular tranexamic acid seems to be effective in reducing post-operative blood loss in primary TKA patients.