Objective To explore the effect of postoperative intraarticular injection of tranexamic acid combined with temporary occlusion of the drainage tube for four hours on the postoperative blood loss and adverse reaction incidence of patients underwent total hip replacement (THA).Methods Eighty-four THA patients in Xiangcheng Hospital of Traditional Chinese Medicine from April 2015 to June 2016 were divided into observation group and control group according to random number table,42 cases in each group.The patients in the two groups were treated with THA under general anesthesia.The patients in the observation group were injected with tranexamic acid into the joint cavity,and the patients in the control group were injected with physiological saline into the joint cavity.The drainage tube was clamped provisionally for 4 hours.The postoperative blood loss,adverse reaction incidence and the levels of hemoglobin (Hb),hematocrit,activated partial thromboplastin time (APTT),prothrombin time(PT) and D-dimer at the time points of before treatment,2 days and 3 months after operation were compared between the two groups.Results The postoperative drainage volume,postoperative blood loss volume,occult blood loss volume and total blood loss volume in the observation group were less than those in the control group (P ＜ 0.05).There was no significant difference in preoperative Hb and hematocrit levels between the two groups (P ＞ 0.05).On the second day after operation,the levels of Hb and hematocrit in the observation group were significantly higher than those in the control group (P ＜ 0.05).There was no significant difference in Hb and hematocrit levels between the two groups three months after operation (P ＜ 0.05).The Hb,hematocrit levels on the second day after operation were significantly lower than those before operation in the two groups (P ＜ 0.05).There was no significant difference in the levels of Hb and hematocrit before and three months after operation(P ＜ 0.05).There was no significant difference in the levels of APTT,PT and D-dimer between the two groups at the time points of before treatment,two days and three months after operation (P ＞ 0.05).There was no significant difference in the levels of APTT,PT and D-dimer at the time points of before treatment,two days and three months after operation in the two groups (P ＞ 0.05).Three months after operation,lower limb swelling occurred in one case (2.38 ％) of the 42 cases in the control group,lower limb swelling and lower limb ecchymosis occurred in one case (2.38 ％)of the 42 cases in the observation group respectively;there was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion Intraarticular injection of tranexamic acid combined with temporary occlusion of the drainage tube for 4 hours can effectively reduce the blood loss after THA,and does not increase the risk of venous thrombosis after operation,and the safety is good,which is conducive to the early rehabilitation of body function.%目的 观察人工全髋关节置换术(THA)患者术后关节腔内注射氨甲环酸联合临时夹闭引流管4h对患者术后失血量及不良反应发生率的影响.方法 抽取2015年4月至2016年6月项城市中医院收治的84例THA患者,通过随机数字表法分为观察组和对照组,每组42例.2组患者均于全身麻醉下实施THA,术后观察组患者于关节腔内注入氨甲环酸,对照组患者于关节腔内注入等剂量生理盐水,2组患者均临时夹闭引流管4h.比较2组患者术后失血及术前、术后第2天和3个月时的血红蛋白(Hb)、红细胞比容、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、D-二聚体水平及不良反应发生率.结果 观察组患者术后引流量、术后失血量、隐性失血量、总失血量均显著少于对照组(P＜0.05).2组患者术前Hb、红细胞比容水平比较差异均无统计学意义(P＞0.05).术后第2天观察组患者Hb、红细胞比容水平高于对照组(P＜0.05);术后3个月时2组患者Hb、红细胞比容水平比较差异无统计学意义(P＞0.05).2组患者术后第2天Hb、红细胞比容水平与术前比较均降低(P＜0.05);术后3个月Hb、红细胞比容水平与术前比较差异均无统计学意义(P＞0.05).术前及术后第2天、3个月,2组患者之间APTT、PT、D-二聚体水平比较差异均无统计学意义(P＞0.05);术前、术后第2天及3个月,2组患者组内两两比较,APTT、PT、D-二聚体水平差异均无统计学意义(P＞0.05).术后3个月,对照组42例中发生下肢肿胀1例(2.38％),观察组42例中发生下肢肿胀1例(2.38％)、下肢淤斑1例(2.38％),2组患者的不良反应发生率比较差异无统计学意义(P＞0.05).结论 关节腔内注射氨甲环酸结合术后临时夹闭引流管4h可有效减少髋关节置换术后失血量,且不会增加术后静脉血栓形成发生风险,安全性较高,有利于患者机体功能及早康复.
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