鸡尾酒疗法对初次全膝关节置换术后失血量的影响及安全性评价
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摘要
目的探讨鸡尾酒疗法关节囊周围局部注射对控制初次行全膝关节置换手术失血量的有效性及安全性。方法回顾性分析2015年6月~2016年10月在中国中医科学院广安门医院南区骨二科行全膝关节置换患者90例,根据治疗方案分为治疗组45例和对照组45例,治疗组采用鸡尾酒疗法膝关节囊周围局部注射,50 mL关节腔内灌注;对照组采用生理盐水关节腔内灌注。术中两组均采用骨蜡局部封堵止血,术后夹闭引流管3 h,术后24 h拔除引流管,分别记录术后引流量、隐性失血量、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),国际标准化比值(INR)、D-二聚体(D-dimer),观察患者下肢血栓发生例数。结果治疗组患者术后显性失血量、隐性失血量少于对照组,输血人数少于对照组,差异有高度统计学意义(P<0.01);两组化验PT、APTT、INR、D-dimer比较差异无统计学意义(P>0.05);两组血栓发生率差异无统计学意义(P>0.05)。结论鸡尾酒疗法能有效减少初次全膝关节置换围术期失血量,是一种行之有效、安全的治疗方法。
Objective To investigate the effectiveness and safety of cocktail drug injection on blood loss and safety evaluation of local injection after primary total knee arthroplasty(TKA). Methods Ninety patients who received primary TKA from June 2015 to October 2016 in Guang′anmen Hospital South district of China Academy of Chinese Medicine Sciences was retrospectively analysed and divided into treatment group and control group, with 45 cases in each group.Treatment group was treated with cocktail drug injection around knee joint capsule and 50 m L intra-articular injection,the control group were treated with saline intra-articular infusion. The bone wax was used to stop the bleeding in the two groups, and the drainage tube was clamped for 3 hours and removed 24 hours after the operation. Postoperative drainage, occult blood loss, prothrombin time(PT), activated partial thromboplastin time(APTT), international normalized ration(INR), D-dimer value and deep venous thrombosis cases were recorded in both group. Results The dominant blood loss and hidden hemorrhage in the treatment group were less than the control group, the number of blood transfusion was less than the control group, the differences were highly statistically significant(P < 0.01). Both groups had no statistically significant in PT, APTT, INR, D-dimer value(P > 0.05). The incidence of thrombosis was no statistically significant between the two groups(P >0.05). Conclusion The cocktail drug injection thearapy is an effective and safe method to control the amount of blood loss during the operation of primary TKA.
Objective To investigate the effectiveness and safety of cocktail drug injection on blood loss and safety evaluation of local injection after primary total knee arthroplasty(TKA). Methods Ninety patients who received primary TKA from June 2015 to October 2016 in Guang′anmen Hospital South district of China Academy of Chinese Medicine Sciences was retrospectively analysed and divided into treatment group and control group, with 45 cases in each group.Treatment group was treated with cocktail drug injection around knee joint capsule and 50 m L intra-articular injection,the control group were treated with saline intra-articular infusion. The bone wax was used to stop the bleeding in the two groups, and the drainage tube was clamped for 3 hours and removed 24 hours after the operation. Postoperative drainage, occult blood loss, prothrombin time(PT), activated partial thromboplastin time(APTT), international normalized ration(INR), D-dimer value and deep venous thrombosis cases were recorded in both group. Results The dominant blood loss and hidden hemorrhage in the treatment group were less than the control group, the number of blood transfusion was less than the control group, the differences were highly statistically significant(P < 0.01). Both groups had no statistically significant in PT, APTT, INR, D-dimer value(P > 0.05). The incidence of thrombosis was no statistically significant between the two groups(P >0.05). Conclusion The cocktail drug injection thearapy is an effective and safe method to control the amount of blood loss during the operation of primary TKA.
引文
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[14]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[15]Gross JB.Estimating allowable blood loss:corrected for dilution[J].Anesthesiology,1983,58(3):277-80.
[16]Nadler SB,Hidalgo JH,Bloch T.Prediction of blood volume in normal human adults[J].Surgery,1962,51(2):224-232.
[17]Jawhar A,Shah V,Sohoni S,et al.Joint line changes after primary total knee arthroplasty:navigated versus nonnavigated[J].Knee Surg Sports Traumatol Arthrosc,2013,21(10):2355-2362.
[18]刘昊,刘宁,柴宏伟,等.氨甲环酸对初次人工全膝关节置换术隐性失血与术后膝关节功能恢复的影响[J].现代仪器与医疗,2016,22(1):107-109.
[19]Sehat KR,Evans RL,Newman JH.Hidden blood loss following hip and knee arthroplasty.Correct management of blood loss should take hidden loss into account[J].J Bone Joint Surg Br,2004,86(4):561-565.
[20]韩宁,姚建华,黄炎,等.氨甲环酸对全膝关节置换术后出血、异体输血及自体引流血回输的影响[J].中国输血杂志,2016,29(3):242-245.
[21]万伏银,郭万首,程立明,等.局部应用骨蜡和氨甲环酸在全膝关节置换术中止血作用的比较[J].中国矫形外科杂志,2016,24(3):193-197.
[22]Kerr DR,Kohan L.Local infiltration analgesia:a technique for the control of acute postoperative pain follow ing knee and hip surgery:a case study of 325 patients[J].Acta Ort-hop,2008,79(2):174-183.
[23]朱剑熹,李康华.鸡尾酒疗法治疗全髋关节置换患者术后疼痛效果的meta分析[J].中国现代医学杂志,2014,24(16):95-99.
[24]Lee KJ,Min BW,Bae KC,et al.Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty[J].Clin Orthop Surg,2009,1(3):155-160.
[25]Mccormack PL.Tranexamic acid:a review of its use in the treatment of hyperfibrinolysis[J].Drugs,2012,72(5):585-617.
[26]曾兵,刘刚,贺志盛,等.氨甲环酸关节腔内注射联合置换后3 h夹闭引流管对膝关节单髁置换失血量的影响[J].中国组织工程研究,2016,20(22):3197-3204.
[27]Wong J,Abrishami A,EI BH,et al.Topical application of tranexamic acid reduc es postoperative blood loss in total knee arthroplasty:a randomized,controlled trial[J].J Bone Joint Surg Am,2010,92(15):2503-2513.
[28]Gilbody J,Dhotar HS,Perruccio AV,et al.Topical Tranexamic Acid Reduces Transfusion Rates in Total Hip and Knee Arthroplasty[J].J Arthroplasty,2014,29(4):681-684.
[2]Seo JG,Moon YW,Park SH,et al.The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2013,21(8):1869-1874.
[3]Craik JD,Ei Shafie SA,Kidd AG,et al.Can local administration of tranexamic acid during total knee arthroplasty reduce blood loss and transfusion requirements in the absence of surgical drains?[J].Eur J Orthop Surg Traumatol,2014,24(3):1-6.
[4]Alshryda S,Mason J,Vaghela M,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total knee replacement:a randomized controlled trial(TRANX-K)[J].J Bone Joint Surg Am,2013,95(21):1969-1974.
[5]Zhang H,Chen J,Chen F,et al.The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty:a meta-analysis[J].Knee Surg Sports Traumatol Arthrosc,2012,20(9):1742-1752.
[6]Ritter MA,Davis KE,Davis P,et al.Preoperative malalignment increases risk of failure after total knee arthroplasty[J].J Bone Joint Surg Am,2013,95(2):126-131.
[7]Yamaguchi S,Ohno G,Kitamura J.Evaluation of perioperative blood loss and transfusion in total knee arthroplasty[J].Masui,2014,63(9):1029-1033.
[8]Ma J,Huang Z,Shen B,et al.Blood management of staged bilateral total knee arthroplasty in a single hospitalization period[J].J Orthop Surg Res,2014,9(1):1-7.
[9]Daniilidis K,Tibesku CO.A comparison of conventional and patient-specific instruments in total knee arthroplasty[J].Int Orthop,2014,38(3):503-508.
[10]Formby PM,Pickett AM,Van Blarcum GS,et al.The Use of Intravenous Tranexamic Acid in Patients Undergoing Total Hip or Knee Arthroplasty:A Retrospective Analysis at a Single Military Institution[J].Mil Med,2015,180(10):1087-1090.
[11]Hsu CH,Lin PC,Kuo FC,et al.A regime of two intravenous injections of tranexamic acid reduces blood loss in minimally invasive total hip arthroplasty:a prospective randomised double-blind study[J].Bone Joint J,2015,97-B(7):905-910.
[12]Bryan AJ,Sanders TL,Trousdale RT,et al.Intravenous Tranexamic Acid Decreases Allogeneic Transfusion Requirements in Periacetabular Osteotomy[J].Orthopedics,2016,39(1):1-5.
[13]Huang GP,Jia XF,Xiang Z,et al.Tranexamic Acid Reduces Hidden Blood Loss in Patients Undergoing Total Knee Arthroplasty:A Comparative Study and Meta-Analysis[J].Med Sci Monit,2016,22:797-802.
[14]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[15]Gross JB.Estimating allowable blood loss:corrected for dilution[J].Anesthesiology,1983,58(3):277-80.
[16]Nadler SB,Hidalgo JH,Bloch T.Prediction of blood volume in normal human adults[J].Surgery,1962,51(2):224-232.
[17]Jawhar A,Shah V,Sohoni S,et al.Joint line changes after primary total knee arthroplasty:navigated versus nonnavigated[J].Knee Surg Sports Traumatol Arthrosc,2013,21(10):2355-2362.
[18]刘昊,刘宁,柴宏伟,等.氨甲环酸对初次人工全膝关节置换术隐性失血与术后膝关节功能恢复的影响[J].现代仪器与医疗,2016,22(1):107-109.
[19]Sehat KR,Evans RL,Newman JH.Hidden blood loss following hip and knee arthroplasty.Correct management of blood loss should take hidden loss into account[J].J Bone Joint Surg Br,2004,86(4):561-565.
[20]韩宁,姚建华,黄炎,等.氨甲环酸对全膝关节置换术后出血、异体输血及自体引流血回输的影响[J].中国输血杂志,2016,29(3):242-245.
[21]万伏银,郭万首,程立明,等.局部应用骨蜡和氨甲环酸在全膝关节置换术中止血作用的比较[J].中国矫形外科杂志,2016,24(3):193-197.
[22]Kerr DR,Kohan L.Local infiltration analgesia:a technique for the control of acute postoperative pain follow ing knee and hip surgery:a case study of 325 patients[J].Acta Ort-hop,2008,79(2):174-183.
[23]朱剑熹,李康华.鸡尾酒疗法治疗全髋关节置换患者术后疼痛效果的meta分析[J].中国现代医学杂志,2014,24(16):95-99.
[24]Lee KJ,Min BW,Bae KC,et al.Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty[J].Clin Orthop Surg,2009,1(3):155-160.
[25]Mccormack PL.Tranexamic acid:a review of its use in the treatment of hyperfibrinolysis[J].Drugs,2012,72(5):585-617.
[26]曾兵,刘刚,贺志盛,等.氨甲环酸关节腔内注射联合置换后3 h夹闭引流管对膝关节单髁置换失血量的影响[J].中国组织工程研究,2016,20(22):3197-3204.
[27]Wong J,Abrishami A,EI BH,et al.Topical application of tranexamic acid reduc es postoperative blood loss in total knee arthroplasty:a randomized,controlled trial[J].J Bone Joint Surg Am,2010,92(15):2503-2513.
[28]Gilbody J,Dhotar HS,Perruccio AV,et al.Topical Tranexamic Acid Reduces Transfusion Rates in Total Hip and Knee Arthroplasty[J].J Arthroplasty,2014,29(4):681-684.