CAJ | 학술논문

背景：氨甲环酸在减少人工关节置换后出血方面的应用越来越多，但其使用方法及剂量仍存在争议，是近几年研究的热点。目的：探讨关节腔注射氨甲环酸对单侧全膝关节置换后患者失血量及肢体周径变化的影响。方法：将北京大学中日友好医院骨科2013年3至10月收治的行初次单侧全膝关节置换的90例患者随机分为氨甲环酸组与对照组，男19例，女71例；其中氨甲环酸组30例患者在止血带释放前关节囊缝合后局部关节腔注射浓度为3%氨甲环酸稀释溶液50 mL，60例患者局部注射同等容量生理盐水作为对照组，两组患者年龄、身高、体质量指数、抗凝方式、假体类型、止血带使用时间及术前诊断比较差异均无显著性意义(P>0.05)。记录患者术中及术后失血量和输血量、术后第1天引流量，测量术前及术后术侧膝上10 cm肢体周径，术后连续复查血常规。结果与结论：氨甲环酸组和对照组手术总失血量、术后第1天引流量与术侧肢体周径变化情况比较差异均无显著性意义(P>0.05)，术后隐性失血量氨甲环酸组明显少于对照组(t=-2.683，P<0.05)。提示全膝关节置换过程中关节腔内注射氨甲环酸能明显减少患者术后隐性失血量，且不影响置换后肢体周径变化。
배경：안갑배산재감소인공관절치환후출혈방면적응용월래월다，단기사용방법급제량잉존재쟁의，시근궤년연구적열점。목적：탐토관절강주사안갑배산대단측전슬관절치환후환자실혈량급지체주경변화적영향。방법：장북경대학중일우호의원골과2013년3지10월수치적행초차단측전슬관절치환적90례환자수궤분위안갑배산조여대조조，남19례，녀71례；기중안갑배산조30례환자재지혈대석방전관절낭봉합후국부관절강주사농도위3%안갑배산희석용액50 mL，60례환자국부주사동등용량생리염수작위대조조，량조환자년령、신고、체질량지수、항응방식、가체류형、지혈대사용시간급술전진단비교차이균무현저성의의(P>0.05)。기록환자술중급술후실혈량화수혈량、술후제1천인류량，측량술전급술후술측슬상10 cm지체주경，술후련속복사혈상규。결과여결론：안갑배산조화대조조수술총실혈량、술후제1천인류량여술측지체주경변화정황비교차이균무현저성의의(P>0.05)，술후은성실혈량안갑배산조명현소우대조조(t=-2.683，P<0.05)。제시전슬관절치환과정중관절강내주사안갑배산능명현감소환자술후은성실혈량，차불영향치환후지체주경변화。
BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.