Ryu J, Sakamoto A, Honda T, Saito S
Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan.
Bull Hosp Jt Dis. 1997;56(4):251-4.
We attempted to decrease the amount of postoperative bleeding after total knee arthroplasty (TKA) by clamping the suction drain and through retrograde infusion of saline containing a low concentration of epinephrine. When TKA was completed and the sutured wound was bandaged, 50 ml of saline containing epinephrine diluted to 1:200,000 and 0.5 g of antibiotic was injected into the knee joint via the inserted suction drain. The drain was clamped for 20 hours and then unclamped to begin aspiration until 48 hours after surgery. To clarify the effectiveness of this method, patients were divided into three groups. Group I consisted of 116 knees (in 95 patients) infused with 50 ml saline containing a low dose of epinephrine: Group II was composed of 70 knees (42 patients) infused with 50 ml saline only; and Group III included 97 knees (78 patients) who did not undergo this drain-clamp method. The average amount of postoperative bleeding was 207 ml in Group I, 255 ml in Group II (p < 0.01), and 501 ml in Group III (p < 0.001). With this method of using saline with a low dose of epinephrine and sustained clamping of up to 20 hours, we have been able to operate on elderly patients with rheumatoid arthritis without blood transfusion, even in cases of simultaneous bilateral TKA. Drain-clamping with saline infusion effectively controlled postoperative bleeding after TKA, and when epinephrine was added to the saline, the hemostatic effect was even greater than that of saline alone.
我们试图通过夹闭吸引引流管以及逆行输注含低浓度肾上腺素的生理盐水来减少全膝关节置换术（TKA）后的出血量。当TKA完成且缝合伤口包扎好后，将50毫升稀释至1:200,000的含肾上腺素生理盐水和0.5克抗生素经插入的吸引引流管注入膝关节。引流管夹闭20小时，然后松开开始抽吸，直至术后48小时。为了阐明该方法的有效性，将患者分为三组。第一组包括116个膝关节（95例患者），输注50毫升含低剂量肾上腺素的生理盐水；第二组由70个膝关节（42例患者）组成，仅输注50毫升生理盐水；第三组包括97个膝关节（78例患者），未采用这种引流管夹闭方法。第一组术后平均出血量为207毫升，第二组为255毫升（p<0.01），第三组为501毫升（p<0.001）。通过使用低剂量肾上腺素生理盐水并持续夹闭长达20小时的这种方法，我们已经能够在不输血的情况下为类风湿性关节炎老年患者进行手术，即使是在双侧同时进行TKA的情况下。用生理盐水夹闭引流管有效地控制了TKA后的术后出血，并且当在生理盐水中加入肾上腺素时，止血效果甚至比单独使用生理盐水时更好。
