冷冻氨甲环酸注射液对全膝关节表面置换术后失血量的影响

Effect of frozen tranexamic acid injection on the blood loss after total knee arthroplasty

摘要:

目的：探讨全膝关节表面置换术（total knee arthroplasty，TKA）后关节腔内灌注冷冻氨甲环酸注射液对术后失血量的影响。方法：健康成年新西兰大白兔（雌雄未分）45只，按照随机分组的方法分为3组，建立TKA模型，术毕关节腔内留置引流管，逐层缝合切口，通过引流管向兔膝关节腔内分别注入A组：冷冻生理盐水注射液3 ml（0 ℃）；B组：常温氨甲环注射液3 ml（30 mg/ml）；C组：冷冻氨甲环酸注射液3 ml（30 mg/ml，0 ℃）。术后引流管夹闭4 h后开放行持续负压引流，术后24 h拔除引流管,记录各实验对象术后切口的引流量及术后第3 d血红蛋白（hemoglobin，Hb）的下降幅度。结果：术后24 h，3组实验对象切口引流量分别为A组（9.61±1.31） ml，B组（6.37±1.25） ml，C组（4.13±0.88） ml，C组术后平均引流量明显少于A组（P=0.000）和B组P=0.000）术后的切口引流量；术后第3 d 3组实验对象的Hb下降幅度分别为A组（22.80±3.23） g/L，B组（17.73±4.16） g/L，C组（13.80±3.82） g/L，C组术后第3 天的Hb下降幅度明显低于A组（P=0.000）和B组（P=0.006）的Hb下降幅度。结论：兔膝TKA术后关节腔内灌注冷冻氨甲环酸注射液较常温氨甲环酸注射液相比，更能够有效减少术后引流量和术后Hb的下降幅度。

Abstract:

Objective：To study the effects of using frozen tranexamic acid for intra-articular injection on blood loss after total knee arthroplasty（TKA）. Methods：Totally 45 New Zealand white rabbits unsexed were randomly divided into 3 groups to build the TKA operation model. After operation，a drainage tube was placed in the articular cavity，then the incision was sutured. Different solutions were injected in articular cavity in 3 groups by drainage tubes：in group A，normal ice normal saline 3 ml（0 ℃）；in group B，normal temperature tranexamic acid 3 ml（concentration of 30 mg/ml）；in group C：frozen tranexamic acid 3 ml（concentration of 30 mg/ml，0 ℃）. The drainage tube was clamped for 4 h，then opened to keep continuous vacuum aspiration. The volumes of drained blood at the 24 h and the decreasing of Hb level at the third day after operation were recorded and compared. Results：At the 24 h after operation，the volumes of drained blood in 3 groups were group A（9.61 ± 1.31） ml，group B（6.37±1.25） ml，group C（4.13±0.88） ml. The volumes of drained blood in the group C was fewer than that of in the group A（P=0.000） and group B（P=0.000）. The decreasing ranges of Hb in 3 groups were group A（17.73±4.16） g/L，group B（22.80±3.23） g/L，group C（13.80± 3.82） g/L. The decreasing range of Hb in group C was fewer than that in group A（P=0.000） and group B（P=0.006）. Conclusion：The frozen tranexamic acid can reduce the volumes of drained blood and the decrease Hb more effective than the normal temperature tranexamic acid when it is injected in the rabbit knee joint cavity after TKA.