Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Adv Ther. 2021 Feb;38(2):1143-1154. doi: 10.1007/s12325-020-01596-4. Epub 2020 Dec 21.
The current study was conducted to evaluate the effect of different applications of tranexamic acid (TXA) on perioperative blood transfusion rate and postoperative pain in unilateral total knee arthroplasty.
This prospective study included a total of 102 patients undergoing unilateral total knee arthroplasty in our hospital from November 2017 to October 2019. On the basis of different TXA administration methods, these patients were randomly assigned to a surface treatment group (50 cases were treated with intraoperative spraying and drug-soaked gauze to cover the wound combined with local injection into the articular cavity) and control group (52 cases were given TXA by intravenous drip combined with local injection into the articular cavity) by random number table method. Clinical data were recorded and evaluated in the two groups. A total of five surgeons participated in the study.
In the surface treatment group, the operation time, hospital stay, tourniquet time, and blood transfusion rate were significant lower compared with the control group, and there was no significant difference in the incision length between the two groups. Our results showed that intraoperative blood loss, postoperative drainage, postoperative blood loss, total blood loss, and the incidence of deep venous thrombosis in the surface treatment group were significantly lower than those in the control group. Our results demonstrated that the surface treatment group reported significantly lower degree of pain compared with the control group at 1 day and 3 days after the operation. However, 7 days after the operation, the degree of pain in the surface treatment group did not differ significantly from that in the control group. In addition, the results of blood coagulation indexes showed that the values of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), and hemoglobin (HGB) in the surface treatment group did not differ significantly from those in the control group before the operation (P > 0.05).
In terms of applications of TXA, the method of intraoperative spraying and drug-soaked gauze covering the wound combined with local injection into the articular cavity can reduce the amount of bleeding and the rate of blood transfusion, and alleviate the degree of pain with high safety profile.
本研究旨在评估不同氨甲环酸（TXA）应用方式对单侧全膝关节置换术围手术期输血率和术后疼痛的影响。
本前瞻性研究纳入 2017 年 11 月至 2019 年 10 月在我院行单侧全膝关节置换术的 102 例患者。根据 TXA 应用方式的不同，采用随机数字表法将患者分为表面处理组（50 例术中采用喷洒和浸药纱布覆盖伤口，并结合关节腔内局部注射）和对照组（52 例静脉滴注 TXA 联合关节腔内局部注射）。记录并评估两组的临床资料。共有 5 位外科医生参与了这项研究。
在表面处理组中，手术时间、住院时间、止血带时间和输血率明显低于对照组，两组切口长度无明显差异。结果显示，术中出血量、术后引流量、术后失血量、总失血量、深静脉血栓形成发生率均明显低于对照组。结果表明，与对照组相比，表面处理组术后 1 天和 3 天疼痛程度明显较低。然而，术后 7 天，表面处理组的疼痛程度与对照组无显著差异。此外，凝血指标结果显示，表面处理组患者的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、D-二聚体（D-D）和血红蛋白（HGB）值在术前与对照组相比无显著差异（P＞0.05）。
在 TXA 的应用方面，术中喷洒和浸药纱布覆盖伤口联合关节腔内局部注射的方法可减少出血量和输血率，并减轻疼痛程度，且安全性高。
