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氨甲环酸联合肾上腺素对全膝关节置换术失血量及膝关节功能恢复的影响

彭中鸿,  刘劲松,  李溪,  李根涛,  庞佳宁

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文章导航 > 昆明医科大学学报  > 2017 >  38(10): 83-89
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引用本文: 彭中鸿, 刘劲松, 李溪, 李根涛, 庞佳宁. 氨甲环酸联合肾上腺素对全膝关节置换术失血量及膝关节功能恢复的影响[J]. 昆明医科大学学报, 2017, 38(10): 83-89.
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Citation: Peng Zhong Hong , Liu Jing Song , Li Xi , Li Gen Tao , Pang Jia Ning . Influence of Tranexamic Acid Combined with Epinephrine on Blood Loss and Knee Function Recovery of Patients with Total Knee Arthroplasty[J]. Journal of Kunming Medical University, 2017, 38(10): 83-89.
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氨甲环酸联合肾上腺素对全膝关节置换术失血量及膝关节功能恢复的影响

  • 昆明医科大学第一附属医院骨科

基金项目: 

基金： 云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2013FB144);

Influence of Tranexamic Acid Combined with Epinephrine on Blood Loss and Knee Function Recovery of Patients with Total Knee Arthroplasty

Funds: 

基金： 云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2013FB144);

摘要

    摘要
  • 摘要: 目的 探讨静滴氨甲环酸 (TXA) 联合关节腔注入肾上腺素 (EPI) 对初次单侧人工全膝关节置换术 (TKA) 失血量及膝关节早期功能恢复的影响.方法 选取2015年2月至2016年12月昆明医科大学第一附属医院骨科收治的122例初次行单侧TKA治疗的患者为研究对象, 按不同的给药方式采用随机数字表法分为四组.TXA+EPI组 (n=31) :松止血带前10 min给予TXA静滴 (10 mg/kg) , 在缝合关节囊结束前向关节腔内注入EPI稀释液50 m L (1:200 000) , 注射后夹闭引流管2 h;TXA组 (n=31) :于松止血带前10 min给予TXA静滴 (10mg/kg) , 同时术后夹闭引流管2 h;EPI组 (n=30) :在缝合关节囊结束前向关节腔内注入EPI稀释液50 m L (1:200 000) , 注射后夹闭引流管2 h;对照组 (n=30) :仅术后夹闭引流管2 h.观察四组患者手术时间、总失血量、术后引流量、隐性失血量、术后输血率、术后35 d髌上及髌下10 cm周径平均变化值、术后7 d膝关节HSS评分, 术后7 d完善双下肢血管超声, 随访3月, 明确血栓发生情况.结果 TXA+EPI组、TXA组、EPI组较对照组在总失血量、术后引流量、隐性失血量、术后输血率、术后35 d髌上及髌下10 cm周径平均变化值上均显著降低 (P<0.05) , 但在术后引流量上, EPI组较TXA组减少更加明显, 差异显著 (P<0.05) , 其余相比差异无统计学意义 (P>0.05) ;术后7 d HSS评分TXA+EPI组要高于其余3组 (P<0.05) .结论 氨甲环酸联合肾上腺素明显减少了初次单侧TKA术后失血, 减轻了TKA术后膝关节肿胀, 促进了患者早期膝关节的功能锻炼, 加速了膝关节功能的康复, 有一定的应用价值, 但有可能造成伤口延迟愈合等并发症, 临床应用需谨慎.
    Abstract: Objective To investigate the effects of intravenous infusion of tranexamic acid (TXA) combined with epinephrine (EPI) on the early functional recovery of joints of patients with total unilateral artificial knee arthroplasty (TKA) . Methods A total of 122 patients with unilateral TKA treated with orthopedic treatment from February 2015 to December 2016 in Kunming Medical University were selected as the subjects. The random number table was used to divided them into four groups according to different methods. TXA + EPI group (n=31) :intravenous infusion of tranexamic acid (10 mg/kg) was given 10 min before the hemostatic tourniquet, and 50 ml (1: 200 000) of adrenaline dilution was injected into the joint cavity before the end of the suture capsule. (n=31) : intravenous infusion of tranexamic acid (10 mg/kg) was given to the tourniquet 10 min before the hemostatic tourniquet, and the drainage tube was clamped for 2 hours. The EPI group (n=30) : only after the injection of drainage tube 2 h (1: 200 000) , injection of the drainage tube after injection of 2 h;control group (n=30) :only after the closure of the drainage tube 2 h. The operative time, total blood loss, postoperative drainage volume, occult blood loss, postoperative blood transfusion rate, postoperative blood transfusion rate, postoperative thickness of 10 cm on patellar and patellofemps were observed on 3 to 5 days postoperation. The deep vein thrombosis7 d after surgery was observed by lower extremity vascular ultrasound examination, and patients were followed up for3 months. Rsults Four patients in the TXA + EPI group had an incisional healing and extended to 3 weeks. The remaining three groups of patients were wound healing, 2 weeks or so stitches. There was no significant difference in the HSS score between the four groups (P>0.05) . TXA + EPI group, TXA group, EPI group (P<0.05) , but there was no significant difference between the two groups (P <0.05) , but there was no significant difference between the two groups (P<0.05) , but the total blood loss, postoperative drainage volume, hidden blood loss, postoperative blood transfusion rate (P<0.05) . There was no significant difference between the EPI group and the rest group (P>0.05) . The level of TXA + EPI in the EPI group was higher than that in the other three groups (P>0.05) (P<0.05) Conclusion Tranexamic acid combined with adrenaline can significantly reduce the first unilateral artificial TKA postoperative blood loss, reduce the knee swelling after TKA, and promote the patient's early knee functional exercise, accelerate knee function recovery, there is a certain application value, but may cause delayed wound healing and other complications, clinical application need to be cautious.
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