局部应用氨甲环酸不放置引流对降低全膝置换隐性失血的疗效

目的探讨局部应用氨甲环酸、不放置引流对降低人工全膝关节置换(TKA)后隐性失血的疗效。方法选择60例行单侧TKA患者,随机分两组,A组(30例):关节腔内应用氨甲环酸,不放置引流;B组(30例):不应用氨甲环酸,放置引流。比较两组患者术中及术后失血量、隐性失血量、输液量、输血量、患肢周径变化等指标,术前和术后3 h检查D-二聚体和相关凝血指标,术后连续复查血常规。结果术中失血量两组比较差异无统计学意义(P0.05),术后失血量和隐性失血量两组比较差异均有统计学意义(P0.05)。两组术中输液量比较差异无统计学意(P0.05),术后24 h输液量两组比较差异有统计学意义(P0.05)。术后输血量A组(480 ml±140 ml)少于B组(908 ml±248 ml)(P0.05)。术后血红蛋白和红细胞压积B组明显低于A组(P0.05)。术后3 h的D-二聚体A组为(0.92±0.45)mg/L,B组为(1.22±0.67)mg/L,均明显高于术前的(0.36±0.12)mg/L和(0.35±0.14)mg/L(P0.05),且B组高于A组(P0.05)。术后凝血指标两组比较差异无统计学意义(P0.05)。两组患肢周径变化差异均无统计学意义(P0.05)。结论TKA中局部应用氨甲环酸、不放置引流明显减少了术后隐性失血量,同时减少了输血量和输血率,且不影响凝血功能。

Topical application effect of tranexamic acid without drainage to lower the curative effect of ;hidden loss of blood in total knee arthoplasty

Objective To explore the topical application effect of tranexamic acid without drainage on reducing the hidden bleeding after total knee arthoplasty ( TKA) .Methods Sixty patients with unilateral TKA routine were ran-domly divided into two groups , group A ( n =30 ): articular cavity application tranexamic acid without drainage;group B ( n=30):no tranexamic acid with indwelling drainage .It was compared in two groups of patients with intra-and post-operative blood loss ,hidden blood loss , transfusion volume ,blood transfusion volume , affected limb week di-ameter change etc many indexs , pre-and post-operative 3 h D-dimer and related blood coagulation indexes , postoper-ative continuous review of routine blood .Results Intraoperative blood loss difference between the two groups had no statistical significance (P>0.05), postoperative blood loss and hidden blood loss difference between the two groups had statistical significance (P<0.05).There was no significant difference between the two groups in the intraopera-tive transfusion volume (P>0.05), but 24 h postoperation, the difference was statistically significant (P<0.05). Postoperative blood transfusion volume in group A (480 ml ±140 ml) was less than group B (908 ml ±248 ml) ( P<0.05).Postoperative hemoglobin concentration and red blood cells deposited for group B was lower than that in group A (P<0.05).Postoperative 3 h,D-dimer for group A was (0.92 ±0.45) mg/L,group B was (1.22 ±0.67) mg/L, were both significantly higher than that of the preoperative [(0.36 ±0.12) mg/L and (0.35 ±0.14) mg/L] (P<0.05), and group B was higher than group A (P<0.05).Postoperative blood coagulation index comparing differences between the two groups had no statistical significance (P>0.05).There was no significant difference be-tween the two groups in the changes of affected limb week diameter (P>0.05).Conclusions TKA in topical appli-cation of tranexamic acid , don′t place drainage , can significantly reduce the postoperative hidden blood loss volume , while reducing the volume and rate of blood transfusion , and does not affect the function of blood coagulation .