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关节内注射氨甲环酸对单髁膝关节置换术围手术期失血的影响。

Intra-Articular Injection of Tranexamic Acid on Perioperative Blood Loss During Unicompartmental Knee Arthroplasty.

机构信息

Department of Orthopaedics, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).

Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland).

出版信息

Med Sci Monit. 2019 Jul 9;25:5068-5074. doi: 10.12659/MSM.914817.

Abstract

BACKGROUND Tranexamic acid (TXA) is safe and effective in total knee arthroplasty (TKA) for the prevention of bleeding. However, the role of TXA during unicompartmental knee arthroplasty (UKA) remains unclear. This study aimed to compare operative blood loss in patients undergoing UKA treated with an intra-articular injection of TXA with controls undergoing UKA without TXA. MATERIAL AND METHODS The prospective study included 101 patients who underwent UKA between January 2014 to March 2018. All patients completed a preoperative routine examination and were randomized to the study group (n=54) and the control group (n-47). The study group was given an articular injection of TXA (1.5 g in 50 ml normal saline) after the fascia was closed; the control group was injected with the same volume of normal saline. Blood volumes were measured from the drainage tube of the two groups during 48 hours. Total blood loss, postoperative drainage, hidden blood loss, blood transfusion rates, postoperative hemoglobin values, indicators of coagulation function, and the rates of wound complications were recorded. RESULTS Total blood loss in the study group was 745.6±105.1 ml, total drainage volume was 353.9±79.5 ml, and the hidden blood loss was 391.7±80.5 ml, which were all significantly lower when compared with the control group (P<0.05). None of the patients in the two groups suffered complications of surgery. CONCLUSIONS Intra-articular injection of TXA significantly reduced the total blood loss in patients who underwent UKA and did not increase the rate of complications.

摘要

背景

氨甲环酸(TXA)在全膝关节置换术(TKA)中安全有效,可预防出血。然而,TXA 在单髁膝关节置换术(UKA)中的作用仍不清楚。本研究旨在比较行 UKA 治疗的患者关节内注射 TXA 与未行 TXA 治疗的 UKA 患者的手术失血量。

材料和方法

前瞻性研究纳入了 2014 年 1 月至 2018 年 3 月期间行 UKA 的 101 例患者。所有患者均完成了术前常规检查,并随机分为研究组(n=54)和对照组(n=47)。研究组在筋膜关闭后给予关节内注射 TXA(1.5 g 溶于 50 ml 生理盐水);对照组注射相同体积的生理盐水。两组患者在 48 小时内通过引流管测量血容量。记录总失血量、术后引流量、隐性失血量、输血率、术后血红蛋白值、凝血功能指标及伤口并发症发生率。

结果

研究组总失血量为 745.6±105.1 ml,总引流量为 353.9±79.5 ml,隐性失血量为 391.7±80.5 ml,均明显低于对照组(P<0.05)。两组患者均无手术并发症发生。

结论

UKA 术中关节内注射 TXA 可显著减少患者总失血量,且不会增加并发症发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5e3/6636410/879ce87f2d0c/medscimonit-25-5068-g001.jpg

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