摘要
目的探讨采用关节内注射氨甲环酸联合引流管夹闭3 h方案减少初次单膝关节置换术患者围术期失血量的有效性和安全性。方法选取2013年12月—2014年2月安徽医科大学附属省立医院骨科行单侧首次全膝关节置换术的老年患者90例(90膝),采用随机数字表法将患者分为试验组与对照组,每组45例。患者均完善术前常规检查,同时行双下肢静脉彩超,试验组于手术关闭筋膜层后关节内注射氨甲环酸并夹闭引流管3 h,对照组关节内注射20 ml 0.9%氯化钠溶液并维持引流管开放,两组患者引流管均于术后48 h拔除。记录术前两组患者年龄、性别、左/右侧、体质指数、手术时间、美国麻醉师协会(ASA)评分、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平,术前及术后1、3 d血红蛋白及血细胞比容(HCT),总失血量、术后引流量、隐性失血量、输血量。结果两组患者年龄、性别、左/右侧、体质指数、手术时间、ASA评分、PT、APTT、FIB水平比较,差异均无统计学意义(P>0.05)。两组患者术前及术后1、3 d血红蛋白及HCT比较,差异均有统计学意义(P<0.05);治疗方法与治疗时间存在交互作用(P<0.05)。试验组患者术后总失血量、术后引流量、隐性失血量、输血量较对照组均减少(P<0.05)。两组患者的手术切口均一期愈合,且均未出现严重并发症和不良反应,术后第7天复查双下肢静脉彩超均未发现静脉血栓。结论关节内注射氨甲环酸联合引流管夹闭3 h方案可有效减少初次单膝关节置换术后的血液丢失,同时不增加下肢深静脉血栓等发生率,该方案有效、安全。
Objective To explore the efficacy and safety of combined application of intra- articular injection of tranexamic acid and clamping the drainage tube for 3 hours in reducing blood loss of primary unilateral total knee arthroplasty. Methods 90 patients who received primary unilateral total knee arthroplasty in Department of Orthopaedics of Provincial Hospital Affiliated to Anhui Medical University from December 2013 to February 2014, were equally divided into experiment group（ 45 cases） and control group（ 45 cases）,all patients received preoperative routine examination and the deep vein colour duplex ultrasonography of both lower limbs. Patients in experiment group received intra- articular injection of tranexamic acid group with clamping the drainage tube for 3 hours, patients in control group received the same volume of physiological saline injection and the drainage tube maintained open,the drainage tubes in all patients were removed 48 hours after surgery. Age, gender, left or right side, body mass index（ BMI）, duration of operation, American society of anesthesiologist（ ASA） score,prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,fibrinogen（ FIB） level,hemoglobin level and hematocrit（ HCT） before surgery,hemoglobin level and HCT 1 day and 3 days after surgery,the total blood loss, postoperative suction drainage, the hidden blood loss and blood transfusion volume were recorded for both groups. Results There was no significant difference in age, gender, left or right side, BMI, duration of operation, ASA score,PT,APTT and FIB level between two groups（ P 〉0. 05）. There were significant differences in hemoglobin level and HCT before surgery,1 day and 3 days after surgery between two groups（ P 〈0. 05）; there was significant interaction between treatment method and treatment time（ P〈 0. 05）. Postoperative total blood loss,postoperative suction drainage, the hidden blood loss and blood transfusion volume of patients in experiment group were significantly less than those in control group（ P 〈0. 05）. Operative incisions of two groups of patients were primary healing,serious complications and adverse reactions were not observed after surgery,venous thrombosis was not found by deep vein colour duplex ultrasonography of both lower limbs 7 days after surgery. Conclusion Combined application of intra- articular injection of tranexamic acid and clamping the drainage tube for 3 hours can reduce blood loss significantly after the primary unilateral total knee arthroplasty without increasing the occurrence of deep- vein thrombosis,the method is effective and safe.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第6期657-660,664,共5页
Chinese General Practice
关键词
关节成形术
置换
膝关节
氨甲环酸
失血
手术
Arthroplasty
replacement
Knee joint
Tranexamic acid
Blood loss
surgical
