| Background:At present,the main treatment for moderate and severe osteoarthritis of the hip or knee is artificial arthroplasty.It can obviously relieve the pain of the patients,improve the joint function of the patients,and then improve the quality of life of the patients.With the development and progress of medicine,Postoperative complications of total hip replacement and total knee replacement,therapeutic effect is improved.However,artificial arthroplasty has a large trauma and a lot of perioperative bleeding,which affects the prognosis of patients.Therefore,reducing the total blood loss in perioperative period to ensure that the patients can obtain good rehabilitation effect has become the focus of attention of the broad range of joint surgeons.Some scholars believe that hyperfibrinolysis caused by surgical procedures is a major factor in perioperative blood loss.Although the advanced concept of minimally invasive surgery and the increasingly perfect preoperative preparation plan can significantly reduce intraoperative bleeding,it is difficult to effectively control the blood loss caused by hyperfibrinolysis.Tranexamic acid(TXA)is a commonly used artificial synthetic plasminogen inhibitor in clinic,through competitive inhibition,the lysine binding sites on plasminogen molecules can be blocked inversely,so that plasminogen can not bind to fibrin,inhibit the degradation of fibrin,stabilize the clot,and achieve the effect of hemostasis.It has been reported that the application of Tranexamic acid in major orthopaedic surgery can effectively reduce the total blood loss by about 1/3,and significantly reduce the perioperative blood transfusion rate of patients without increasing the risk of venous thrombosis.As a result,most orthopedic physicians have a more acceptable hemostatic effect on the hemostatic effect of carbamoic acid.It has been proved by a large number of studies that the hemostatic effect of either single intravenous drip of Tranexamic acid,single articular cavity instillation of Tranexamic acid or intravenous drip combined articular cavity instillation of Tranexamic acid has been fully affirmed.However,there is no consensus as to which method of administration can achieve the best hemostatic effect.Objective:The purpose of this study was to evaluate the clinical hemostatic effects of three common administrations of Tranexamic acid for the patients who have had the first unilateral total knee arthroplasty(TKA)or had the first unilateral total hip arthroplasty(THA).It provides important theoretical reference and technical support for the correct use of Tranexamic acid and the improvement of clinical blood management scheme.Methods:Using the doctor workstation system,From December 2011 to December 2017,the patients who have had the first unilateral TKA or had the first unilateral THA,owing to severe osteoarthritistotal,there were 570 patients who met the Inclusion criteria in our hospital.288 patients underwent the first unilateral TKA,According to whether or not to use Tranexamic acid,the patients were divided into four groups:group knee A(75 patients without Tranexamic acid),group knee B(73 patients received intravenously)and group knee C(71 patients with intravenous drip combined articular cavity instillation).Group knee D(69 patients with articular cavity instillation);282 patients underwent the first unilateral THA,according to whether or not to use Tranexamic acid,the patients were divided into four groups:group hip A(73 patients without Tranexamic acid),group hip B(76 patients received intravenously)and group hip C(67 patients with intravenous drip combined articular cavity instillation).Group hip D(66 patients with articular cavity instillation).Through the doctor workstation system,the medical information of relevant patients is read one by one,such as name,general data,sex,age,operation time,height and weight are collected and recorded.The hemoglobin content before and after operation,the erythrocyte count before and after operation,the hematokrit before and after operation and postoperative drainage were collected.And The total blood loss of patients during perioperative was calculated by Gross equation and Nadler equation.Finally,the optimal route of administration of tranexamic acid was comprehensively analyzed by comparing the post-operative hemoglobin content,postoperative erythrocyte count,postoperative anemia rate,total blood loss volume and postoperative drainage volume of patients in each group.Results:1.In TKA,intravenous drip of TXA combined with intraarticular perfusion of TXA did not have a good synergistic effect on reducing the total blood loss and the postoperative drainage in perioperative period,but also not have a good synergistic effect on increasing the postoperative erythrocyte count and the postoperative hemoglobin content.2.In TKA,either single intravenous drip of TXA,single articular cavity instillation of TXA,or intravenous drip combined articular cavity instillation of TXA,all could effectively reduce the rate of postoperative anemia in patients,but there was no significant difference in postoperative anemia rate among them.3.In THA,the total blood loss and the postoperative drainage of patients during perioperative period could be effectively reduced by either intravenous drip of TXA or intraarticular infusion of TXA.Intravenous drip of TXA combined with intraarticular infusion of TXA had a good synergistic effect on reducing the total blood loss and the postoperative drainage during perioperative period.4.In THA,the postoperative erythrocyte count and the postoperative hemoglobin content of the patients could be effectively increased by either intravenous drip of TXA or intraarticular infusion of TXA.Intravenous drip of TXA combined with intraarticular infusion of TXA had a good synergistic effect on increasing the postoperative erythrocyte count and the postoperative hemoglobin content of the patients.5.In THA,either single intravenous drip of Tranexamic acid,single articular cavity instillation of Tranexamic acid or intravenous drip combined articular cavity instillation of Tranexamic acid,all could effectively reduce the rate of postoperative anemia in patients,The incidence of postoperative anemia was the lowest is the group of intravenous drip of TXA and intraarticular infusion of TXA,followed by the group is the single intravenous drip of TXA,and the group of patients with single intraarticular infusion of TXA was a little better than that of the group without TXA.Conclusion:1.In TKA,Preoperative intravenous drip combined with postoperative intraoperative infusion of tranexamic acid had no significant synergistic effect in reducing blood loss,and there was no significant difference in total blood loss between the IV+IA treatment group and the IA treatment group.2.1n THA,Preoperative intravenous drip combined with postoperative intraarticular instillation of tranexamic acid has a significant synergistic effect in reducing blood loss,and the IV+IA treatment group had the lowest total blood loss and the lowest postoperative anemia rate. |
PDF Full Text Request