半程使用止血带联合静滴氨甲环酸对全膝关节置换术失血量的影响

摘要

目的 探讨人工全膝关节置换术(total knee arthroplasty,TKA)中半程使用止血带联合静脉滴注氨甲环酸对TKA围手术期失血量的影响.方法 回顾分析2013年3月至2016年8月在我科行初次TKA手术且符合纳入标准的122例膝骨关节炎患者的临床资料,其中43例术中全程使用止血带并不使用氨甲环酸(A组),41例全程使用止血带并术中静脉滴注氨甲环酸(B组),38例半程使用止血带并术中静脉滴注氨甲环酸(C组).收集并比较三组患者性别、年龄、侧别、体重指数(body mass index,BMI)、术前及术后血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit,Hct)水平,记录手术时长、术中出血量、术后引流量、术后输血量及输血例数,记录术前及术后1年膝关节美国特种外科医院评分(hospital for special surgery,HSS),用Gross方程计算患者围手术期总失血量及隐性失血量.结果 A组和B、C组围手术期总失血量比较差异有统计学意义(P＜0.001),B、C两组总失血量比较差异无统计学意义(P=0.731);A组和B、C组围手术期隐性失血量比较差异有统计学意义(P＜0.001),B、C两组隐性失血量比较差异有统计学意义(P=0.001).术后输血A组13例(30.23％),B组3例(7.31％),C组2例(5.12％),术后输血率A组和B、C组比较差异有统计学意义(P＜0.05),B、C组比较差异无统计学意义(P＞0.05).三组患者术后1年HSS评分差异无统计学意义(F=0.384,P=0.681).结论 TKA术中静脉使用氨甲环酸能大幅度减少围手术期总失血量,降低输血率;半程使用止血带能缩短术中止血带使用时间,但并不会增加手术时间及围手术期失血量;建议对于血栓栓塞高风险患者减少止血带的使用.%Objective To investigate influence of limited tourniquet use combined with intravenous tranexamic acid on blood loss perioperative total knee arthroplasty (TKA).Methods The clinical data of 122 patients with knee osteoarthritis undergoing total knee arthroplasty were analyzed retrospectively from March 2013 to August 2016 in our department.The 43 cases were treated with tourniquet without using tranexamic acid (Group A),41 patients were treated with tourniquet and intravenous infusion of tranexamic acid (group B),38 cases were treated with limited tourniquet use and intravenous infusion of tranexamic acid (group C).The sex,age,body mass index (BMI),hemoglobin (Hb) and hematocrit (Hct) of the patient were collected and compared between the three groups.The length of operation,intraoperative blood loss,postoperative drainage,the number of blood transfusion and HSS score were recorded.The Gross formula was used to calculate the total blood loss and the hidden blood loss perioperative total knee arthroplasty.Results The total blood loss in group A and group B and group C was significantly different (P＜0.001).There was no significant difference in total blood loss between group B and group C (P =0.731).The hidden blood loss in group A and group B and group C was significantly different (P＜0.001).The hidden blood loss in group B and group C,the difference was statistically significant (P=0.001).There were 13 cases (30.23％) in group A,3 cases (7.31％) in group B,2 cases (5.12 ％) in group C transfusing,and the rate of transfusion in group A,group B and group C were statistically significant (P＜0.05).There was no significant difference in HSS score between the three groups (F-0.384,P =0.681).Conclusion The use of tranexamic acid in TKA can significantly reduce the total blood loss during the operation and reduce the transfusion rate.Limited tourniquet use in total knee arthroplasty can shorten the time of tourniquet,but it will not increase the operation time and perioperative blood loss.It is recommended for patients with high risk of thromboembolism to reduce the use of tourniquets.