Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1869-74. doi: 10.1007/s00167-012-2079-2. Epub 2012 Jun 24.
Reduction in blood loss during surgery stabilizes hemodynamic status and aids in recovery after total knee arthroplasty (TKA). In this study, the authors examined whether different administration routes of tranexamic acid (TNA) might affect the amount of blood loss after TKA.
A total of 150 patients were prospectively allocated to each of the three groups (intravenous, intra-articular, and placebo group) and underwent unilateral TKA. During closing the operative wound, TNA (1.5 g mixed in 100 cc of saline) was administered intravenously or intra-articularly according to the enrolled group, and an equivalent volume of normal saline was administered into the knee joint cavity and intravenously in the placebo group, respectively. The amount of blood loss and transfusion, and changes in haemoglobin levels were documented accordingly.
The mean blood loss in the intravenous, intra-articular, and placebo groups were 528 ± 227, 426 ± 197, and 833 ± 412 ml, respectively. About 66 % (intravenous), 80 % (intra-articular), and 6 % (placebo) of each group did not require transfusion for any reason, and the mean amount of transfusion was 273.6, 129.6, and 920.8 ml, respectively. Preoperative haemoglobin values decreased by 1.6 ± 0.8, 1.8 ± 0.8, and 2.0 ± 0.9 mg/dl, respectively.
Compared to intravenous administration, intra-articular administration of TNA seems to be more effective in terms of reducing blood loss and transfusion frequency. TNA may improve the general conditions of patients given TKA by maintaining a hemodynamically stable state, aiding in recovery, and reducing the chance of transfusion-associated side effects and complications.
II.
手术过程中减少失血量可稳定血液动力学状态，并有助于全膝关节置换术后（TKA）的恢复。在这项研究中，作者研究了不同途径给予氨甲环酸（TNA）是否会影响 TKA 后的失血量。
150 例患者前瞻性地分配至三组（静脉组、关节内组和安慰剂组），并接受单侧 TKA。在关闭手术切口时，根据入组组别，TNA（1.5g 混合在 100cc 生理盐水）静脉内或关节内给药，而安慰剂组膝关节腔内给予等量生理盐水和静脉内给药。记录失血量和输血量以及血红蛋白水平的变化。
静脉组、关节内组和安慰剂组的平均失血量分别为 528±227ml、426±197ml 和 833±412ml。每组约 66%（静脉组）、80%（关节内组）和 6%（安慰剂组）无需因任何原因输血，平均输血量分别为 273.6ml、129.6ml 和 920.8ml。术前血红蛋白值分别下降 1.6±0.8mg/dl、1.8±0.8mg/dl 和 2.0±0.9mg/dl。
与静脉内给药相比，关节内给予 TNA 似乎在减少失血量和输血频率方面更有效。TNA 通过维持血液动力学稳定状态、促进恢复以及减少输血相关副作用和并发症的机会，可能改善接受 TKA 的患者的一般状况。
II。
