中华损伤与修复杂志（电子版）
中華損傷與脩複雜誌（電子版）
중화손상여수복잡지（전자판）
Chinese Journal of Injury Repair and Wound Healing
2014年
6期
640-645
,共6页
杨朝君%孙智文%张爱民%韩立业
楊朝君%孫智文%張愛民%韓立業
양조군%손지문%장애민%한립업
关节成形术,置换,膝%氨甲环酸%止血,手术%引流术
關節成形術,置換,膝%氨甲環痠%止血,手術%引流術
관절성형술,치환,슬%안갑배산%지혈,수술%인류술
Arthroplasty,replacement,knee%Tranexamic acid%Hemostasis,surgical%Drainage
目的：探讨局部应用氨甲环酸联合引流管夹闭3h对单侧全膝关节置换术出血量的影响。方法2012年6月至2014年6月，前瞻性选择100例患有骨性关节炎行初次全膝关节置换术（TKA）的患者，随机分为两组：实验组（n＝51），关节置换完成后松止血带前自引流管向关节腔注入氨甲环酸10 mL（含1000 mg）＋0．9％氯化钠10 mL，注入后引流管夹闭3 h；对照组（n＝49），同期关节腔注入0．9％氯化钠溶液20 mL，注射后引流管未夹闭。比较两组患者术后1、7、14 d血红蛋白含量、术后最大血红蛋白丢失量、引流量、隐性失血量、总失血量、输血量、输血率、术后1 dD-二聚体值、术后7 d下肢静脉血栓（VTE）发生率、皮下瘀斑面积＞1％发生率。其中计量资料的比较采用两独立样本t检验，率的比较采用χ2检验。结果术后1、7、14 d血红蛋白平均含量实验组高于对照组，差异有统计学意义（P＜0．05）。术后最大血红蛋白丢失量、引流量、隐性失血量实验组少于对照组，差异有统计学意义（P＜0．05）。实验组、对照组患者总失血量分别为（712．6±260．5）mL、（1109．6±350．5）mL，两组比较差异有统计学意义（t＝6．45，P＜0．05）。实验组与对照组输血量分别为（27．0±49．2）mL、（232．0±119．3）mL，两组比较差异有统计学意义（t＝11．30，P＜0．05）；实验组与对照组输血患者分别为5例和21例，输血率分别为9．8％和42．9％，两组比较差异有统计学意义（χ2＝14．19， P＜0．05）。两组术后1 d D二聚体含量均升高，实验组低于对照组，差异有统计学意义（t＝2．65，P＜0．05）；术后7 d 两组患者静脉多普勒超声检查发现VTE发生率比较差异无统计学意义（χ2＝0．24， P＞0．05），术后皮下瘀斑面积＞1％的发生率实验组少于对照组，差异有统计学意义（χ2＝4．67，P＜0．05）。结论 TKA术中局部应用氨甲环酸联合引流管夹闭3 h可显著降低TKA术后失血量、输血率及皮下瘀斑面积＞1％发生率，并未增加血栓形成风险，是安全有效的。
目的：探討跼部應用氨甲環痠聯閤引流管夾閉3h對單側全膝關節置換術齣血量的影響。方法2012年6月至2014年6月，前瞻性選擇100例患有骨性關節炎行初次全膝關節置換術（TKA）的患者，隨機分為兩組：實驗組（n＝51），關節置換完成後鬆止血帶前自引流管嚮關節腔註入氨甲環痠10 mL（含1000 mg）＋0．9％氯化鈉10 mL，註入後引流管夾閉3 h；對照組（n＝49），同期關節腔註入0．9％氯化鈉溶液20 mL，註射後引流管未夾閉。比較兩組患者術後1、7、14 d血紅蛋白含量、術後最大血紅蛋白丟失量、引流量、隱性失血量、總失血量、輸血量、輸血率、術後1 dD-二聚體值、術後7 d下肢靜脈血栓（VTE）髮生率、皮下瘀斑麵積＞1％髮生率。其中計量資料的比較採用兩獨立樣本t檢驗，率的比較採用χ2檢驗。結果術後1、7、14 d血紅蛋白平均含量實驗組高于對照組，差異有統計學意義（P＜0．05）。術後最大血紅蛋白丟失量、引流量、隱性失血量實驗組少于對照組，差異有統計學意義（P＜0．05）。實驗組、對照組患者總失血量分彆為（712．6±260．5）mL、（1109．6±350．5）mL，兩組比較差異有統計學意義（t＝6．45，P＜0．05）。實驗組與對照組輸血量分彆為（27．0±49．2）mL、（232．0±119．3）mL，兩組比較差異有統計學意義（t＝11．30，P＜0．05）；實驗組與對照組輸血患者分彆為5例和21例，輸血率分彆為9．8％和42．9％，兩組比較差異有統計學意義（χ2＝14．19， P＜0．05）。兩組術後1 d D二聚體含量均升高，實驗組低于對照組，差異有統計學意義（t＝2．65，P＜0．05）；術後7 d 兩組患者靜脈多普勒超聲檢查髮現VTE髮生率比較差異無統計學意義（χ2＝0．24， P＞0．05），術後皮下瘀斑麵積＞1％的髮生率實驗組少于對照組，差異有統計學意義（χ2＝4．67，P＜0．05）。結論 TKA術中跼部應用氨甲環痠聯閤引流管夾閉3 h可顯著降低TKA術後失血量、輸血率及皮下瘀斑麵積＞1％髮生率，併未增加血栓形成風險，是安全有效的。
목적：탐토국부응용안갑배산연합인류관협폐3h대단측전슬관절치환술출혈량적영향。방법2012년6월지2014년6월，전첨성선택100례환유골성관절염행초차전슬관절치환술（TKA）적환자，수궤분위량조：실험조（n＝51），관절치환완성후송지혈대전자인류관향관절강주입안갑배산10 mL（함1000 mg）＋0．9％록화납10 mL，주입후인류관협폐3 h；대조조（n＝49），동기관절강주입0．9％록화납용액20 mL，주사후인류관미협폐。비교량조환자술후1、7、14 d혈홍단백함량、술후최대혈홍단백주실량、인류량、은성실혈량、총실혈량、수혈량、수혈솔、술후1 dD-이취체치、술후7 d하지정맥혈전（VTE）발생솔、피하어반면적＞1％발생솔。기중계량자료적비교채용량독립양본t검험，솔적비교채용χ2검험。결과술후1、7、14 d혈홍단백평균함량실험조고우대조조，차이유통계학의의（P＜0．05）。술후최대혈홍단백주실량、인류량、은성실혈량실험조소우대조조，차이유통계학의의（P＜0．05）。실험조、대조조환자총실혈량분별위（712．6±260．5）mL、（1109．6±350．5）mL，량조비교차이유통계학의의（t＝6．45，P＜0．05）。실험조여대조조수혈량분별위（27．0±49．2）mL、（232．0±119．3）mL，량조비교차이유통계학의의（t＝11．30，P＜0．05）；실험조여대조조수혈환자분별위5례화21례，수혈솔분별위9．8％화42．9％，량조비교차이유통계학의의（χ2＝14．19， P＜0．05）。량조술후1 d D이취체함량균승고，실험조저우대조조，차이유통계학의의（t＝2．65，P＜0．05）；술후7 d 량조환자정맥다보륵초성검사발현VTE발생솔비교차이무통계학의의（χ2＝0．24， P＞0．05），술후피하어반면적＞1％적발생솔실험조소우대조조，차이유통계학의의（χ2＝4．67，P＜0．05）。결론 TKA술중국부응용안갑배산연합인류관협폐3 h가현저강저TKA술후실혈량、수혈솔급피하어반면적＞1％발생솔，병미증가혈전형성풍험，시안전유효적。
Objective To explore the effectiveness of topical tranexami acid combined with temporary clamping of drain on reducing blood loss in total knee arthroplasty(TKA).Methods From June 2012 to June 2014, the prospective and randomized study was conducted in the institute.Total of 100 patients,who were diagnosed primary osteoarthritis to undergo a primary TKA,were randomized into study group and control group with 5 1 cases in study group and 49 cases in control group.In study group,the drain was clamped for 3 hours after the operation and the patient received 1 000 mg tranexami acid and 10 mL physiological saline through the drain tube at the end of the operation.In control group,the drain was not clamped after the operation and the patient received 20 mL physiological saline respectively.The postoperative hemoglobin level,maximum hemoglobin loss,wound drainage,blood loss ,the volume of blood transfusion,the number of patients inquiring blood transfusion,D-Dimer,venous thrombo embolism (VTE) rate,ecchymosis rate were recorded and compared between the two groups.Two sided independent t-test was used to compare all normally distriuted continuous variables,and the chi-square test was used for rate test. Results The hemoglobin concentration in study group was significantly higher than that in control group on day 1,7,14 after TKA(P<0.05).The maximum hemoglobin loss,total drainage,hidden blood loss and maximum hemoglobin loss in study group were significantly less than those in control group (P<0.05).The total blood loss in study group was significantly less than that in control group [(712.6 ±260.5)mL]vs (1109.6 ±350.5)mL(t=6.45,P<0.05).The volume of blood transfusion were (27.0 ±49.2)mL vs (232.0 ±119.3)mL (t=11.30,P<0.05).The patients needing blood transfusion in study group were significantly less than those in control group (5 cases vs 21 cases,χ2 =14.19,P <0.05 ).The blood transfusion rate were 9.8% and 42.9%.D-dimer was higher in one day after TKA than preoperative ones in both group,and there was significant difference in D-dimer between the two groups(t=2.65,P<0.05).In the study,two thromboembolic event occurred in both two groups and there was no significant difference between the two groups(χ2 =0.24,P>0.05 ).The ecchymosis rate in study group was less than that in control group (χ2 =4.67,P <0.05 ).Conclusions Topical tranexami acid combined with temporary clamping of drain 3 hours could reduce postoperative blood loss,blood transfusion,ecchymosis rate without increasing the risk of thromboembolic event after TKA.
