局部应用氨甲环酸减少全膝关节置换术后失血
Topical Tranexamic Acid to Reduce Postoperative Blood Loss in Total Knee Arthroplasty.
作者信息
Wong Jean, El Beheiry Hossam
机构信息
Department of Anesthesia, Toronto Western Hospital, University of Toronto, 2MC-434, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. E-mail address:
Department of Anesthesia, Trillium Health Centre, 100 Queensway West, Mississauga, ON L5B 1B8, Canada. E-mail address:
出版信息
JBJS Essent Surg Tech. 2011 Jun 15;1(1):e4. doi: 10.2106/JBJS.ST.K.00009.
INTRODUCTION
Total knee arthroplasty alleviates pain and restores function in patients with osteoarthritis of the knee, but it is associated with postoperative blood loss resulting in anemia and allogeneic blood transfusion in 10% to 38% of patients.
STEP 1 PREPARE SOLUTION: Prepare tranexamic acid solution using aseptic technique.
STEP 2 APPLY SOLUTION: Apply tranexamic acid solution to the open joint and soft-tissue surfaces.
STEP 3 REMOVE SOLUTION AND CLOSE: Remove tranexamic acid, keeping the tourniquet inflated until the wound is closed and the dressing is applied.
RESULTS & PREOP/POSTOP IMAGES: We showed, in a prospective, double-blinded, placebo-controlled randomized trial, that topical application of tranexamic acid directly into the surgical wound prior to closure at the end of a total knee arthroplasty reduces postoperative bleeding by 20% to 25%, or 300 to 400 mL.
WHAT TO WATCH FOR
IndicationsContraindicationsPitfalls & Challenges.
引言
全膝关节置换术可缓解膝关节骨关节炎患者的疼痛并恢复其功能，但该手术与术后失血有关，会导致贫血，且10%至38%的患者需要接受异体输血。
步骤1 配制溶液：采用无菌技术配制氨甲环酸溶液。
步骤2 应用溶液：将氨甲环酸溶液应用于开放的关节和软组织表面。
步骤3 去除溶液并关闭创口：去除氨甲环酸，保持止血带充气，直到伤口关闭并敷上敷料。
结果与术前/术后影像：在一项前瞻性、双盲、安慰剂对照随机试验中，我们发现，在全膝关节置换术结束时关闭手术伤口前，将氨甲环酸局部应用于手术伤口，可使术后出血量减少20%至25%，即300至400毫升。
注意事项
适应证、禁忌证、陷阱与挑战。
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