中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (33): 5303-5310.doi: 10.12307/2022.806

• 人工假体 artificial prosthesis • 上一篇    下一篇

全膝关节置换中不同体积和剂量氨甲环酸关节腔注射对失血量的影响

刘金磊，殷  力，张  翼，王海涛，卢英姿   

  1. 郑州大学第一附属医院骨科，河南省郑州市   450000
  • 收稿日期:2021-08-18 接受日期:2021-10-11 出版日期:2022-11-28 发布日期:2022-03-30
  • 通讯作者: 殷力，博士，主任医师，硕士生导师，郑州大学第一附属医院骨科，河南省郑州市 450000
  • 作者简介:刘金磊，男，1994年生，河南省周口市人，汉族，郑州大学第一附属医院骨科毕业，硕士，主要从事关节外科的相关研究。
  • 基金资助:
    国家自然科学基金青年科学基金项目(81702663)，项目负责人：张翼；河南省高等学校重点科研项目计划(20A310022)，项目负责人：殷力

Intra-articular tranexamic acid at different volumes and doses affects blood loss during total knee arthroplasty

Liu Jinlei, Yin Li, Zhang Yi, Wang Haitao, Lu Yingzi   

  1. Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • Received:2021-08-18 Accepted:2021-10-11 Online:2022-11-28 Published:2022-03-30
  • Contact: Yin Li, MD, Chief physician, Master’s supervisor, Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • About author:Liu Jinlei, Master, Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • Supported by:
    the National Natural Science Foundation of China (Youth Fund), No. 81702663 (to ZY); Key Scientific Research Project Plan of Higher Education Institutions in Henan Province, No. 20A310022 (to YL)

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摘要：

文题释义：
氨甲环酸：是一种纤溶酶原抑制剂，其本质为一种赖氨酸类似物，可竞争性结合纤溶蛋白酶原上的赖氨酸结合位点，抑制纤维蛋白与纤溶酶原的结合，从而产生良好的止血效果，近年来被广泛应用于骨科、心外科、胸外科等领域的围术期止血。
全膝关节置换失血的原因：①膝关节滑膜血运丰富，术中需进行滑膜切除，大量截骨；②止血带的应用；③术后抗凝药物的应用；④术后早期患膝关节功能锻炼。合理有效地进行围术期血液管理可以减少输血风险，加速患者术后康复，减轻经济负担，这也是骨外科医生亟待解决的问题。

背景：全膝关节置换围术期会产生大量失血，局部应用氨甲环酸可有效降低围术期失血，但关于氨甲环酸的溶液配比目前还尚未统一。
目的：研究全膝关节置换过程中关节腔内注射不同体积和剂量的氨甲环酸溶液对失血量的影响。
方法：选择2019年2月至2020年1月就诊于郑州大学第一附属医院行单侧人工全膝关节置换的患者120例，其中男45例，女75例，年龄42-89岁，采用随机数字表法分为4组，A组在全膝关节置换中关节囊缝合后沿切口处注射氨甲环酸溶液1 g/20 mL，B组在全膝关节置换中关节囊缝合后沿切口处注射氨甲环酸溶液1 g/50 mL，C组在全膝关节置换中关节囊缝合后沿切口处注射氨甲环酸溶液1 g/100 mL，D组在全膝关节置换中关节囊缝合后沿切口处注射氨甲环酸溶液2 g/100 mL，每组30例。比较4组患者术后失血情况、炎症指标、凝血指标、并发症及不良反应及患肢膝关节静息和活动时的目测类比评分。
结果与结论：①失血与输血情况：C、D组引流量、总失血量和血红蛋白下降值均低于A、B组(P < 0.05)，C、D组隐性失血量低于A组(P < 0.05)，B组引流量、总失血量和血红蛋白下降值均低于A组(P < 0.05)，4组输血率和输血量比较差异无显著性意义(P > 0.05)；②炎症与凝血指标：4组术后红细胞沉降率、C-反应蛋白、D-二聚体、纤维蛋白原水平比较差异无显著性意义(P > 0.05)；③并发症及不良反应：所有患者未发生深静脉血栓及其他不良事件；④4组术后3 h、7 d的静息与运动目测类比评分比较差异均无显著性意义(P > 0.05)；⑤结果表明，全膝关节置换中关节腔注射1 g/100 mL氨甲环酸溶液所产生的止血效果好于1 g/20 mL和1 g/50 mL，且不增加术后下肢深静脉血栓和切口愈合不良等并发症的发生风险；1 g/100 mL和2 g/100 mL氨甲环酸溶液具有相同的止血作用，但应用1 g更加经济和便捷，因此推荐全膝关节置换中关节腔注射氨甲环酸溶液的配比为1 g/100 mL。

https://orcid.org/0000-0001-7254-6086 (刘金磊)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨科植入物, 人工假体, 氨甲环酸, 关节内注射, 全膝关节置换, 失血量

Abstract: BACKGROUND: Massive blood loss often produces during the perioperative period of total knee arthroplasty. Local injection of tranexamic acid can effectively reduce perioperative blood loss. However, the protortion of tranexamic acid solution has not been unified.  
OBJECTIVE: To study the effect of intra-articular tranexamic acid at different volumes and doses on blood loss in total knee arthroplasty.
METHODS:  A total of 120 patients aged 42-89 years who underwent unilateral total knee arthroplasty in the First Affiliated Hospital of Zhengzhou University from February 2019 to January 2020, including 45 males and 75 females, were randomly divided into four groups (n=30 per group). Patients undergoing total knee arthroplasty in the A, B, C, and D groups were injected with tranexamic acid solution 1 g/20 mL, 1 g/50 mL,1 g/100 mL, and 2 g/100 mL, respectively, along the incision after joint capsule suturing. Postoperative blood loss, inflammatory indexes, coagulation indexes, complications and adverse reactions, and visual analogue scale scores of the knee joint at resting and active states were compared among the four groups after operation.  
RESULTS AND CONCLUSION: (1) Blood loss and blood transfusion: the drain output, total blood loss and hemoglobin drop in the C and D groups were significantly lower than those in the A and B groups (P < 0.05), and hidden blood loss in the C and D groups was significantly lower than that in the A group (P < 0.05). The drain output, total blood loss, and hemoglobin drop in the B group were lower than those in the A group (P < 0.05). There were no significant differences in blood transfusion rate and blood transfusion among all the groups (P > 0.05). (2) Inflammation and coagulation indexes: There were no significant differences in erythrocyte sedimentation rate, C-reactive protein, D-dimer and fibrinogen among the four groups (P > 0.05). (3) Complications and adverse reactions: No deep vein thrombosis and other adverse reactions occurred in any patients. (4) There was no significant difference in visual analog scale scores at resting and active states among the four groups at 3 hours and 7 days after operation (P > 0.05). (5) In conclusion, intra-articular injection of 1 g/100 mL tranexamic acid solution is better than 1 g/20 mL and 1 g/50 mL in the reduction of blood loss during total knee arthroplasty, without increasing the risk of complications such as deep venous thrombosis and superficial wound necrosis. 1 g/100 mL and 2 g/100 mL tranexamic acid solutions have the same hemostatic effect, but 1 g/100 mL tranexamic acid solution is more economical and convenient in clinical practice. Therefore, 1 g/100 mL tranexamic acid solution is recommended for intra-articular injection in total knee arthroplasty.

Key words: orthopedic implant, artificial prosthesis, tranexamic acid, intra-articular injection, total knee arthroplasty, blood loss

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