Dong Yi-Long, Qian Yue-Nan, Zhong Xi-Qiang, Shen Guang-Jie, Cai Chun-Yuan
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China;
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China.
Zhongguo Gu Shang. 2017 Apr 25;30(4):329-333. doi: 10.3969/j.issn.1003-0034.2017.04.009.
To evaluate the efficacy and safety of one dose tranexamic acid combined with temporary drain lamping in primary unilateral total knee arthroplasty.
Total 160 patients undergoing unilateral primary total knee arthroplasty between January 2012 and December 2013 were randomly divided into four groups(40 cases in each group):group A (the drain was clamped for 2 hours after the operation and the patients received 20 ml physiological saline), group B(the drain was clamped for 2 hours after the operation and the patients received 10 ml tranexamic acid and 10 ml physiological saline), group C (the drain was clamped for 4 hours after the operation and the patients received 20 ml physiological saline) and group D(the drain was clamped for 4 hours after the operation and the patients received 10 ml tranexamic acid and 10 ml physiological saline). The postoperative hemoglobin level, maximum hemoglobin loss, wound drainage, blood loss, the volume of blood transfusion, the number of patients inquiring blood transfusion, venous thrombo embolism rate, and ecchymosis rate were recorded and compared among the four groups.
There was no incision infection, severe hypoxia, and symptomatic pulmonary embolism in these groups. There were significant differences in hemoglobin content one day after operation in each group(=12.26, =0.000), in the hemoglobin content 7 days after operation in each group(=20.74, =0.000), in postoperative drainage in each group(=38.71, =0.000);in the amount of invisible red blood cell loss in each group(=83.41, =0.000), and in total red blood cell loss in each group(=102.68, =0.000). Color Doppler ultrasound examination found that the total incidence of VTE was 3%(5/160) and there were no significant differences in each group(=0.892). There were no significant differences in postoperative subcutaneous ecchymosis area>1% incidence(=0.143).
Topical tranexami acid treatment combined with temporary clamping of drain for 4 hours could reduce postoperative blood loss, blood transfusion, and ecchymosis rate without increasing the risk of thromboembolic event after total knee arthroplasty.
评估单剂量氨甲环酸联合临时夹闭引流管在初次单侧全膝关节置换术中的疗效及安全性。
选取2012年1月至2013年12月期间行单侧初次全膝关节置换术的160例患者，随机分为四组（每组40例）：A组（术后夹闭引流管2小时，患者接受20 ml生理盐水），B组（术后夹闭引流管2小时，患者接受10 ml氨甲环酸和10 ml生理盐水），C组（术后夹闭引流管4小时，患者接受20 ml生理盐水），D组（术后夹闭引流管4小时，患者接受10 ml氨甲环酸和10 ml生理盐水）。记录并比较四组患者术后血红蛋白水平、最大血红蛋白丢失量、伤口引流量、失血量、输血量、询问输血患者人数、静脉血栓栓塞率及瘀斑率。
各组均无切口感染、严重缺氧及症状性肺栓塞发生。各组术后1天血红蛋白含量（F = 12.26，P = 0.000）、术后7天血红蛋白含量（F = 20.74，P = 0.000）、术后引流量（F = 38.71，P = 0.000）、各组无形红细胞丢失量（F = 83.41，P = 0.000）及各组总红细胞丢失量（F = 102.68，P = 0.000）差异均有统计学意义。彩色多普勒超声检查发现VTE总发生率为3%（5/160），各组间差异无统计学意义（F = 0.892）。术后皮下瘀斑面积>1%发生率各组间差异无统计学意义（F = 0.143）。
局部应用氨甲环酸联合临时夹闭引流管4小时可减少全膝关节置换术后失血量、输血量及瘀斑率，且不增加血栓栓塞事件风险。
