Department of Orthopaedic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China.
Department of Cardiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China.
Orthop Surg. 2020 Apr;12(2):582-588. doi: 10.1111/os.12664.
To evaluate the efficacy and safety of combined use of tranexamic acid (TXA) and dexamethasone (DEX) for anti-inflammatory and clinical outcomes after total hip arthroplasty (THA).
A total of 100 patients were included in this randomized, controlled study. Patients in the TXA + DEX group were administered TXA at a dose of 15 mg/kg, which was repeated 3 h after THA, and received 20 mg DEX. In contrast, patients in the TXA group were administered TXA at a dose of 15 mg/kg, which was repeated at 3 h postoperatively. C-reactive protein (CRP), interleukin-6 (IL-6) and pain levels, incidence of postoperative nausea and vomiting (PONV), total blood loss and transfusion rates, postoperative fatigue, range of motion (ROM), length of hospital stay (LOS), analgesic rescue and antiemetic rescue consumption, and complications were compared in both groups.
The CRP and IL-6 levels were lower in the TXA + DEX group than in the TXA group (all P < 0.001) at 24 h, 48 h, and 72 h postoperatively. Patients in the TXA + DEX group had lower pain scores at rest and walking at 24 h postoperatively (all P < 0.001). In the TXA + DEX group, the incidence of PONV was lower (P = 0.005), postoperative fatigue (P < 0.001) was reduced, and analgesia and antiemetic rescue consumption were also reduced. The total blood loss, transfusion rate, LOS and hip ROM were similar in the two groups. There was no thrombosis, infection, or gastrointestinal bleeding in either group.
Compared to TXA alone, the combination of TXA + DEX can reduce postoperative inflammatory response, relieve pain, and reduce PONV and fatigue, without increasing the risk of complications. Therefore, the present study suggested that the combination of TXA + DEX is an effective and safe accelerated rehabilitation strategy for patients receiving primary unilateral THA.
评估氨甲环酸（TXA）与地塞米松（DEX）联合使用在全髋关节置换术（THA）后抗炎和临床结局方面的疗效和安全性。
这项随机对照研究纳入了 100 名患者。TXA+DEX 组患者给予 TXA 剂量 15 mg/kg，THA 后 3 小时重复使用，同时给予 DEX 20 mg；TXA 组患者给予 TXA 剂量 15 mg/kg，术后 3 小时重复使用。比较两组患者术后 C 反应蛋白（CRP）、白细胞介素 6（IL-6）和疼痛水平、术后恶心呕吐（PONV）发生率、总失血量和输血率、术后疲劳、关节活动度（ROM）、住院时间（LOS）、镇痛和止吐药物消耗以及并发症。
术后 24、48 和 72 小时，TXA+DEX 组 CRP 和 IL-6 水平均低于 TXA 组（均 P<0.001）。术后 24 小时，TXA+DEX 组患者静息和活动时疼痛评分均较低（均 P<0.001）。TXA+DEX 组 PONV 发生率较低（P=0.005），术后疲劳（P<0.001）减轻，镇痛和止吐药物消耗也减少。两组总失血量、输血率、LOS 和髋关节 ROM 相似。两组均无血栓、感染或胃肠道出血。
与单独使用 TXA 相比，TXA+DEX 联合使用可减轻术后炎症反应，缓解疼痛，减少 PONV 和疲劳，且不增加并发症风险。因此，本研究表明，TXA+DEX 联合应用是接受初次单侧 THA 患者的一种有效且安全的加速康复策略。
