Banerjee Samik, Issa Kimona, Pivec Robert, McElroy Mark J, Khanuja Harpal S, Harwin Steven F, Mont Michael A
Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland.
J Knee Surg. 2013 Dec;26(6):379-85. doi: 10.1055/s-0033-1353992. Epub 2013 Aug 16.
Bone and soft tissue bleeding often results in substantial amounts of blood loss following total knee arthroplasty. Multiple studies have reported that cumulative blood loss varies between 500 and 1,500 mL in primary settings. Increased perioperative blood loss frequently requires allogeneic blood transfusions to improve the hematocrit and the hemoglobin levels. However, allogeneic transfusion is associated with risks of immunosuppression, transfusion reactions, graft versus host disease, and transmission of infections. To avoid these problems and reduce costs of transfusion, multiple intraoperative pharmacotherapeutic strategies have been developed. The various pharmacotherapeutic agents currently used are tranexamic acid, epsilon-aminocaproic acid, fibrin, thrombin, lavage with epinephrine, and norepinephrine. However, the relative efficacy and the cost-effectiveness of these techniques may vary. Thus, the purpose of this study was to provide a brief overview of the relative efficacy of various intraoperative pharmacological methods currently in use for decreasing blood loss following total knee arthroplasty and describe their potential complications associated with their use.
全膝关节置换术后，骨与软组织出血常导致大量失血。多项研究报告称，在初次手术中，累计失血量在500至1500毫升之间。围手术期失血量增加常常需要输注异体血以提高血细胞比容和血红蛋白水平。然而，异体输血存在免疫抑制、输血反应、移植物抗宿主病及感染传播等风险。为避免这些问题并降低输血成本，已制定了多种术中药物治疗策略。目前使用的各种药物治疗剂有氨甲环酸、ε-氨基己酸、纤维蛋白、凝血酶、肾上腺素灌洗和去甲肾上腺素。然而，这些技术的相对疗效和成本效益可能有所不同。因此，本研究的目的是简要概述目前用于减少全膝关节置换术后失血的各种术中药理学方法的相对疗效，并描述其使用相关的潜在并发症。
