氨甲环酸静脉联合关节腔内注射后引流管夹闭时间对Superpath人工全髋关节置换术失血量的影响

目的探讨在Superpath人工全髋关节置换术中应用氨甲环酸静脉联合关节腔内注射后引流管夹闭时间对术后失血量的影响。方法筛选出75例符合诊断及排除标准的患者随机分为A、B、C、D、E五组,每组15例。五组患者均于切皮前10 min静脉滴注氨甲环酸氯化钠100 mL。缝合关闭切口后,A组通过引流管向关节腔内注射生理盐水50 mL,B、C、D、E组向关节腔内注射氨甲环酸氯化钠溶液50 mL,然后各组均夹闭引流管;A、B两组于夹闭引流管30 min后打开。C、D、E三组患者分别于夹闭引流管60 min、90 min、120 min后打开,记录各组术后48 h引流量、总失血量和隐性失血量及术后第1、3、5天及1个月血红蛋白和红细胞比容、术后输血次数及输血量以及下肢深静脉血栓形成、肺栓塞发生情况。结果 A组患者术后48 h引流量、总失血量和隐性失血量均高于其他四组,A组各项结果与C、D、E三组比较差异均有统计学意义(P0.05),但A、B两组比较差异无统计学意义(P0.05)。引流管内注入氨甲环酸的各组中,随着术后引流管夹闭时间的增加,术后48 h引流量逐渐减少,C、D、E三组术后48 h引流量明显少于B组,C、D、E三组与B组比较差异均有统计学意义(P0.05);从术后夹管60 min开始,随着夹管时间的增加,术后48 h引流量D组和E组较C组减少不明显,C、D、E三组间比较差异无统计学意义(P0.05)。B、C、D、E四组间总失血量和隐性失血量差异无统计学意义(P0.05)。从A组到E组,术后5组的血红蛋白减少量和红细胞比容减少量呈现下降的趋势,但5组之间比较结果显示各组间差异无统计学意义(P0.05)。术后患者未发现下肢深静脉血栓的形成及肺栓塞的发生,术后无患者进行输血。结论静脉滴注联合关节腔内注射氨甲环酸可减少Superpath人工全髋关节置换术围手术期失血量;氨甲环酸注射入关节腔后夹闭引流管的时间对术后止血效果有影响,夹管60 min再开放引流止血效果最佳。

Influence of duration of temporary closure of drainage tube after tranexamic acid application combining intravenous and intraarticular injection on blood loss in patients under through Superpath total hip arthroplastry

Objective To investigate the influence of the duration of temporary closure of the drainage tube after tranexamic acid application combining intravenous and intraarticular injection on postoperative blood loss in patients under through superpath total hip arthroplastry(THA). Methods 75 patients who were eligible for diagnostic and exclusive criteria were randomized into group A, B, C, D and E with 15 patients in each. Patients in all of five groups were treated with 100 mL of tranexamic acid by intravenous drip 10 min before skin incision. After suturing and closing incision, patients in group A were treated 50 mL of normal saline by intraarticular injection through drainage tube. Patients in group B, C, D and E were treated with 50 mL of tranexamic acid by intraarticular injection through drainage tube. Then drainage tubes in all groups were clipped. Drainage tubes in group A and B were open 30 min later.Drainage tubes in group C, D and E were open 60 min, 90 min and 120 min later. The volume of drainage, total blood loss and hidden blood loss 48h after operation in each group were recorded. The hemoglobin and erythrocrit of 1 day,3 days, 5 days and one month later, the times and amounts of postoperative transfusion, the incidence of lower limb deep vein thrombosis and pulmonary embolism were recorded. Results The volume of drainage 48 h after operation, total blood loss and hidden blood loss in group A were more than those in other four groups. Results of each term in group A were significantly different from those in group C, D and E (P<0.05). There were no significant differences of each term between group A and B (P>0.05). Within groups of patients treated with tranexamic acid, volume of drainage 48 h after operation decreased as the duration of drainage clip increased. The volumes of drainage 48h after operation in group C,D and E were significantly different from that in group B(P<0.05). When the duration of drainage clip was 60 min and more, the volumes of drainage 48h after operation in group D and E decreased non-significantly compared with that in group C as the duration of drainage clip increased. The volumes of drainage 48h after operation in group C, D and E were not statistically different(P>0.05). The total blood loss and hidden blood loss in groups B, C, D and E were not statistically different between each other(P>0.05). Though the decrement of hemoglobin and erythrocrit were down trending from group A to group E, there were no statistically differences between each other(P>0.05). No cases were found with lower limb deep vein thrombosis and pulmonary embolism. No cases were treated with transfusion after operation. Conclusion Tranexamic acid application combining intravenous and intraarticular injection could reduce the perioperative blood loss in patients under through superpath THA. The duration of temporary closure of the drainage tube after tranexamic acid intraarticular injection could influence the effectiveness of postoperative hemostasis, and it is best to open the drainage tube 60min after drainage clip.