[1]申震,韩文朝,王晓冰,等.氨甲环酸关节腔注射联合三七散口服对初次全膝关节置换术围手术期失血量的影响[J].中医正骨,2017,29(10):40-43.
　SHEN Zhen,HAN Wenchao,WANG Xiaobing,et al.Effect of intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders on perioperative blood loss in patients who received primary total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(10):40-43.
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氨甲环酸关节腔注射联合三七散口服对初次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29卷
期数:
2017年10期
页码:
40-43
栏目:
临床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Effect of intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders on perioperative blood loss in patients who received primary total knee arthroplasty
作者:
申震; 韩文朝; 王晓冰; 宋山峰; 李百华; 白宗堂; 鲁素玲
河南省濮阳市中医医院,河南 濮阳 457000
Author(s):
SHEN Zhen; HAN Wenchao; WANG Xiaobing; SONG Shanfeng; LI Baihua; BAI Zongtang; LU Suling
Puyang Hospital of Traditional Chinese Medical,Puyang 457000,Henan,China
关键词:
关节成形术; 置换; 膝;  失血; 手术;  围手术期;  注射; 关节内;  氨甲环酸;  三七;  临床试验
Keywords:
Key words arthroplasty; replacement; knee;  blood loss; surgical;  perioperative period;  injections; intra-articular;  tranexamic acid;  panax notoginseng;  clinical trial
摘要:
目的:观察氨甲环酸关节腔注射联合三七散口服对初次全膝关节置换术(total knee arthroplasty,TKA)围手术期失血量的影响。方法:将302例初次接受TKA的患者随机分为2组,151例采用氨甲环酸关节腔注射联合三七散口服治疗(联合治疗组),151例采用氨甲环酸关节腔注射联合安慰剂口服治疗(关节腔注射组)。TKA手术结束关闭关节腔后,向膝关节腔内注射氨甲环酸注射液50 mL。术前3 d至术后14 d连续口服中药配方颗粒三七散,每次4.5 g,每日2次。安慰剂应用方法与三七散相同。术后14 d采用Gross方程计算患者的围手术期失血量,测量患侧与健侧下肢周径差值; 分别于术前3 d及术后1 d、7 d、14 d测量血浆D-二聚体含量。结果:术后14 d,联合治疗组的围手术期失血量低于关节腔注射组[(453.41±61.31)mL,(502.92±46.91)mL,t=7.881,P=0.000]; 联合治疗组的患侧与健侧下肢周径差值低于关节腔注射组[(0.62±0.12)cm,(0.75±0.22)cm,t=6.277,P=0.000]。手术前后不同时间点血浆D-二聚体含量比较,差异有统计学意义,存在时间效应(F=238.157,P=0.000); 2组患者血浆D-二聚体含量总体比较,差异有统计学意义,即存在分组效应(t=3.185,P=0.002); 术前3 d,2组患者血浆D-二聚体含量比较,差异无统计学意义[(0.35±0.15)ng·mL-1,(0.36±0.14)ng·mL-1,t=0.318,P=0.751]; 术后1 d、7 d、14 d时,联合治疗组的血浆D-二聚体含量均低于关节腔注射组[(0.98±0.52)ng·mL-1,(1.15±0.87)ng·mL-1,t=2.048,P=0.041;(0.91±0.42)ng·mL-1,(1.34±0.56)ng·mL-1,t=7.601,P=0.000;(0.73±0.26)ng·mL-1,(0.95±0.47)ng·mL-1,t=5.289,P=0.000]; 时间因素和分组因素存在交互效应(F=403.727,P=0.000)。结论:氨甲环酸关节腔注射联合三七散口服可以减少初次TKA患者围手术期失血量、减轻患肢肿胀程度、降低血浆D-二聚体含量,效果优于单纯氨甲环酸关节腔注射。
Abstract:
ABSTRACT Objective:To observe the effect of intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders on perioperative blood loss in patients who received primary total knee arthroplasty(TKA).Methods:Three hundred and two patients who received primary total TKA were randomly divided into 2 groups,one hundred and fifty-one patients were treated with intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders(combination treatment group),while the others were treated with intra-articular injection of tranexamic acid combined with oral application of placebo(intra-articular injection group).The tranexamic acid injection(50 ml)was injected into knee joint cavity after the articular cavity was closed at the end of the surgery.The panax notoginseng powders or the placebo were administered orally from preoperative day 3 to postoperative day 14,twice a day,4.5 g at a time.The perioperative blood loss was calculated by using Gross equation at postoperative day 14,and the difference between affected side and healthy side in lower limb circumference were measured,and the plasma D-dimer contents were measured at 3 days before the surgery and at 1,7 and 14 days after the surgery respectively.Results:At 14 days after the surgery,the perioperative blood loss was lower in combination treatment group compared to intra-articular injection group(453.41+/-61.31 vs 502.92+/-46.91 ml,t=7.881,P=0.000),and the difference between affected side and healthy side in lower limbs circumference was lower in combination treatment group compared to intra-articular injection group(0.62+/-0.12 vs 0.75+/-0.22 cm,t=6.277,P=0.000).There was statisticaldifference in the plasma D-dimer content between different timepoints before and after the surgery,in other words,there was time effect(F=238.157,P=0.000).There was statistical difference in the plasma D-dimer content between the 2 groups in general,in other words,there was group effect(t=3.185,P=0.002).There was no statistical difference in the plasma D-dimer content between the 2 groups at 3 days before the surgery(0.35+/-0.15 vs 0.36+/-0.14 ng/ml,t=0.318,P=0.751).The plasma D-dimer content was lower in combination treatment group compared to intra-articular injection group at 1,7 and 14 days after the surgery(0.98+/-0.52 vs 1.15+/-0.87 ng/ml,t=2.048,P=0.041; 0.91+/-0.42 vs 1.34+/-0.56 ng/ml,t=7.601,P=0.000; 0.73+/-0.26 vs 0.95+/-0.47 ng/ml,t=5.289,P=0.000).There was interaction between time factor and group factor(F=403.727,P=0.000).Conclusion:The combination therapy of intra-articular injection of tranexamic acid and oral application of panax notoginseng powders can reduce perioperative blood loss,affected limb swelling and plasma D-dimer contents in patients who received primary total TKA,and its curative effect is better than that of monotherapy of intra-articular injection of tranexamic acid.

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备注/Memo

备注/Memo:
基金项目:2015年濮阳市科技攻关项目(150625) 通讯作者:韩文朝 E-mail:690488995@qq.com
更新日期/Last Update: 2018-03-10