[1]王庆东,李付彬,徐向峰,等.氨甲环酸术前静脉滴注联合术中关节内注射对 全膝关节置换术围手术期失血量的影响[J].中医正骨,2016,28(01):24-27.
　WANG Qingdong,LI Fubin,XU Xiangfeng,et al.Effect of preoperative intravenous drip infusion and intraoperative intra-articular injection of tranexamic acid on perioperative blood loss of total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):24-27.
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氨甲环酸术前静脉滴注联合术中关节内注射对 全膝关节置换术围手术期失血量的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年01期
页码:
24-27
栏目:
临床研究
出版日期:
2016-01-20

文章信息/Info

Title:
Effect of preoperative intravenous drip infusion and intraoperative intra-articular injection of tranexamic acid on perioperative blood loss of total knee arthroplasty
作者:
王庆东; 李付彬; 徐向峰; 李杰峰; 金艳南; 康乐; 彭高峰
漯河医学高等专科学校第二附属医院,河南 漯河 462300
Author(s):
WANG Qingdong; LI Fubin; XU Xiangfeng; LI Jiefeng; JIN Yannan; KANG Le; PENG Gaofeng
The Second Affiliated Hospital of Luohe medical high training school,Luohe 462300,Henan,China
关键词:
关节成形术;  置换;  膝;  氨甲环酸;  失血; 手术;  围手术期;  输注; 静脉内;  注射; 关节内;  治疗; 临床研究性
Keywords:
arthroplasty; replacement; knee;  tranexamic acid;  blood loss; surgical;  perioperative period;  infusions; intravenous;  injections; intra-articular;  therapies; investigational
摘要:
目的:观察氨甲环酸(tranexamic acid,TXA)术前静脉滴注联合术中关节内注射对全膝关节置换术(total knee arthroplasty,TKA)围手术期失血量的影响。方法:将64例接受TKA治疗的单侧膝骨关节炎患者随机分为联合用药组和关节注射组,每组32例。2组手术方式及所选假体完全一致。联合用药组在止血带充气前10 min静脉滴注1 g TXA注射液,同时在手术关闭筋膜层后通过引流管逆行向关节内注射TXA溶液(2 g TXA注射液加20 mL生理盐水),并夹闭引流管2 h; 关节注射组仅在手术关闭筋膜层后通过引流管逆行向关节内注射TXA溶液,并夹闭引流管2 h。术后测量2组患者的引流量、术后4 d时的总失血量,并观察下肢深静脉血栓形成(deep venous thrombosis,DVT)的发生情况。结果:2组患者的手术时间和引流量比较,组间差异均无统计学意义[(62.9±4.1)min,(63.8±4.0)min,t=-0.526,P=0.601;(121.00±26.00)mL,(132.00±28.00)mL,t=-1.638,P=0.107]; 联合用药组术后4 d时的总失血量少于关节注射组[(500.00±116.00)mL,(589.00±108.00)mL,t=-3.078,P=0.002]。至术后7 d时联合用药组2例发生DVT,关节注射组1例发生DVT,均为小腿肌间静脉血栓,继续给予原剂量抗凝药物,至术后2周时3例患者的血栓均消失。2组患者的DVT发生率比较,差异无统计学意义(χ2=0.000,P=1.000)。结论:TXA术前静脉滴注联合术中关节内注射可有效减少TKA围手术期失血量,而且不增加发生DVT的风险。
Abstract:
Objective:To observe the effect of preoperative intravenous drip infusion and intraoperative intra-articular injection of tranexamic acid(TXA)on perioperative blood loss of total knee arthroplasty(TKA).Methods:Sixty-four patients with unilateral knee osteoarthritis who were treated with TKA were randomly divided into combination group and intra-articular injection group,32 cases in each group.The two groups were completely consistent with each other in the operative procedures and the selected prosthesis.The patients in combination group were treated with intravenous drip infusion of TXA(1 g)at 10 min before tourniquet inflated and antidromic intra-articular injection of TXA(2 g)through the drainage tube after the fascia were sutured.Moreover,the drainage tubes were closed for 2 hours.The patients in intra-articular injection group were only treated with the monotherapy of antidromic intra-articular injections of TXA.The postoperative drainage,total blood loss and incidence rate of lower extremity deep venous thrombosis(DVT)were measured and compared between the 2 groups.Results:There was no statistical difference in the operation time and the postoperative drainage between the 2 groups(62.9+/-4.1 vs 63.8+/-4.0 min,t=-0.526,P=0.601; 121.00+/-26.00 vs 132.00+/-28.00 mL,t=-1.638,P=0.107).The total blood loss of combination group was less than that of intra-articular injection group at 4 days after the surgery(500.00+/-116.00 vs 589.00+/-108.00 mL,t=-3.078,P=0.002).DVT was found in combination group(2 cases)and intra-articular injection group(1 case)within 7 days postoperatively,and the 3 cases were diagnosed as surae intermuscular venous thrombosisThe anticoagulants were used in former dosage and the thrombus of the 3 patients disappeared at 2 weeks after the surgery.There was no statistical difference in the incidence rate of DVT between the 2 groups(χ2=0.000,P=1.000).Conclusion:Combination of preoperative intravenous drip infusion with intraoperative intra-articular injection of TXA can effectively reduce perioperative blood loss of TKA and do not increase the risk of DVT.

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备注/Memo

备注/Memo:
通讯作者:李付彬 E-mail:385223064@qq.com
更新日期/Last Update: 2016-02-29