背景:将止血带与氨甲环酸(TXA)结合使用不仅可以确保清晰的视野,减少术中失血量,缩短手术时间,但也改善了全膝关节置换术(TKA)中的骨水泥-骨交叉。然而,目前尚无证据证明止血带的血流阻断作用是否会影响TXA的抗纤溶作用,TXA给药的最佳时机尚不清楚。因此,本研究旨在探讨TKA患者在压放止血带前静脉注射第一剂TXA对患者围手术期失血量和疗效的影响.
方法:在这项双盲试验中,90例接受原发性TKA的患者随机分为2组:A组,患者在止血带按压前10分钟(20mg/kg)和后3、6和24小时(10mg/kg)接受静脉TXA,B组,患者接受与A组相同的治疗,但在释放止血带前接受静脉TXA.主要结果是失血的变化,血红蛋白和血细胞比容。次要结果包括手术和止血带时间,输血率,手术肢体的皮下瘀点和圆周变化,视觉模拟量表(VAS)评分,特殊外科医院(HSS)评分,术后住院时间(LOS),并发症和患者满意度。
结果:两组在年龄方面无统计学差异,性别,体重,体重指数(BMI),Kellgren-Lawrence班,术前血容量,术前实验室值,操作和止血带时间,输血率,膝围,术前HSS,或VAS评分(P:n.s.)。术中出血量(IBL)无明显差异(52.7mlvs.63.4ml,P=0.07),隐性失血(HBL)(91.4mlvs.119.9,P=0.4)或总失血量(TBL)(144.1mlvs.183.3ml,A组和B组之间的P=0.72)血红蛋白,血细胞比容和红细胞计数(RBC)在术后第3天降至低点,然后反弹,第21天恢复至正常水平,两组间变化趋势无统计学意义(P:n.s.)。皮下瘀斑发生率无显著差异,膝盖肿胀率,HSS得分,VAS评分,LOS术后,并发症发生率或患者满意度(P:n.s.)。
结论:在止血带按压前静脉注射TXA可有效减少全膝关节置换术患者的失血量。然而,膝关节肿胀率无显著差异,皮下瘀伤和瘀斑发生率,膝关节功能,在原发性TKA中,在止血带按压和释放前静脉给予TXA的患者之间的并发症发生率或满意度。
BACKGROUND: The use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also improves cement-bone inter-digitation in total knee arthroplasty (TKA). However, there is no proof whether the blood flow blocking effect of tourniquet affects the antifibrinolytic effect of TXA, and the optimal timing of TXA administration is still unclear. Therefore, this
study aims to investigate the effect of the first dose of TXA administered intravenously before tourniquet compression and release in TKA on perioperative blood loss and therapeutic efficacy in patients.
METHODS: In this double-blind
trial, 90 patients undergoing primary TKA were randomised into 2 groups: Group A, patients received intravenous TXA 10 min before tourniquet compression (20 mg/kg) and 3, 6 and 24 h later (10 mg/kg), and Group B, patients were treated the same as those in Group A but received intravenous TXA before tourniquet release. The primary outcomes were changes in blood loss, haemoglobin and haematocrit. Secondary outcomes included operation and tourniquet times, blood transfusion rate, subcutaneous petechiae and circumferential changes in the operated limb, visual analogue scale (VAS) score, hospital for special surgery (HSS) score, length of stay (LOS) postoperatively, complications and patient satisfaction.
RESULTS: No statistically significant difference was found between the 2 groups with regard to age, sex, weight, body mass index (BMI), Kellgren-Lawrence class, preoperative blood volume, preoperative laboratory values, operation and tourniquet times, transfusion rate, knee circumference, preoperative HSS, or VAS score (P:n.s.). There was no significant difference in intraoperative blood loss (IBL) (52.7 ml vs. 63.4 ml, P = 0.07), hidden blood loss (HBL) (91.4 ml vs. 119.9, P = 0.4) or total blood loss (TBL) (144.1 ml vs. 183.3 ml, P = 0.72) between Groups A and B. Haemoglobin, haematocrit and red blood cell count (RBC) dropped to a low point on postoperative day 3 and then rebounded, returning to normal levels on day 21, and the trend of change between the 2 groups was not statistically significant (P:n.s.). There was no significant difference in subcutaneous ecchymosis incidence, knee swelling rate, HSS score, VAS score, LOS postoperatively, complication rate or patient satisfaction (P:n.s.).
CONCLUSIONS: TXA was administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. However, there was no significant difference in knee swelling rate, subcutaneous bruising and petechiae incidence, knee function, complication rate or satisfaction between patients who TXA was given intravenously before tourniquet compression and release in primary TKA.