Effects of horse chestnut seed extract on early hidden blood loss and limb circumference changes after total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2014.48.004

Abstract

Abstract:

BACKGROUND: The swelling of limbs after total joint arthroplasty is associated with the hidden blood loss. The main component of horse chestnut seed extract is Aescine, which can protect blood vessels, increase vascular tension, reduce capillary permeability, and exert anti-edema, anti-inflammation, and anti-exudation effect. This extract can prevent and treat post-traumatic swelling of the limbs.
OBJECTIVE: To investigate the pathological mechanisms and effects of horse chestnut seed extract on early hidden blood loss and limb circumference changes after total knee arthroplasty.
METHODS: A total of 150 patients undergoing total knee arthroplasty from January 2013 to September 2013 were retrospectively analyzed. The involved cases were divided into two groups. The test group of 85 cases received oral administration of 0.3 g horse chestnut seed extract, three administrations per day, from the first day after total knee arthroplasty. The administration was given for 14 days. Control group of 65 patients received no
detumescence drugs. There were no significant differences in patient’s age, body height and body mass index between two groups (P > 0.05). Blood routine examination was performed at 1-3 days after total knee arthroplasty. The amounts of intraoperative blood loss, postoperative blood loss, and postoperative blood transfusion were recorded. The hidden blood loss was calculated according to the Gross formula. Perioperative limb circumference above the knees was observed and measured. Two-independent-sample t-test was used to compare the difference between the two groups.
RESULTS AND CONCLUSION: Hidden blood loss between the test group and control group was (590.6±214.2) and (821.2±457.30) mL, respectively, the difference was significant (t=3.238, P=0.021). The postoperative total blood loss and the thigh circumference changes above knee in test group were less significantly than that in control group within 2 and 3 days after surgery (P < 0.05). And there was no statistically significant difference in thigh circumference changes on postoperative 1 day and drainage between the two groups (P > 0.05). Experimental findings indicate that, early application of horse chestnut seed extract can significantly reduce hidden blood loss, significantly relieve postoperative limb swelling, and promote the recovery of limb function after primary total knee arthroplasty. The mechanism of detumescence might be due to the decrease of hidden blood loss and the promotion of venous return.

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

全文链接：

Key words: arthroplasty, replacement, knee, blood loss, surgical, perioperative care, medical

CLC Number:

R318

Gao Fu-qiang, Sun Wei, Ma Jin-hui, Li Zi-rong. Effects of horse chestnut seed extract on early hidden blood loss and limb circumference changes after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7726-7731.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，所有150例行初次全膝关节置换患者均进入结果分析，无中途退出者。 2.2 基线资料比较两组患者年龄、性别、身高、体质量及与抗凝方式等一般资料对称，差异均无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 隐性失血量的计算结果病例统计结果显示：试验组和对照组置换后隐性失血量分别为(590.6±214.2)，(821.2± 457.3) mL，差异有显著性意义(t=3.238，P=0.021)，如图1所示。 2.4 肢体周径变化趋势通过分析两组全膝关节置换后不同时间段肢体周径变化分布趋势发现，在全膝关节置换后早期两组患侧肢体周径均表现为明显的增加，即肿胀增加，置换后第3天尤为显著，但应用马栗种子提取物的试验组肢体周径增加的幅度却明显放缓，肢体肿胀的程度也较对照组轻一些，见图2。 2.5 全膝关节置换后失血与肢体肿胀比较如表2所示，与对照组相比，试验组可显著减少置换后失血总量与隐性失血量，而不影响患者的引流量。两组置换后第1天膝上 10 cm大腿周径变化差异无显著性意义(P > 0.05)，而试验组在全膝关节置换后第2，3天膝上10 cm大腿周径变化均明显小于对照组(P < 0.05)。 2.6 典型病例男性患者，67岁，术前诊断为右膝重度骨关节炎，在腰硬联合麻醉下行右侧全膝关节置换，所选择假体为Nexgen LPS-High Flex，美国Zimmer公司。患者于术日起，口服马栗种子提取物0.3 g，3次/d，连续服药14 d。患者肢体肿胀不严重，功能康复良好，1周内患者的膝关节活动度在0°-90°。随访时间为3个月，随访效果满意，随访期间未出现任何不良事件。 2.7 不良事件两组患者无切口感染、症状性肺栓塞以及下肢深静脉血栓形成等情况出现，未见马栗种子提取物相关药物不良反应。"

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