Total Knee Arthroplasty Perioperative Bleeding Effect On Systemic Inflammatory Response And Pain Control

Objective:To study the effect of hypertension, sex, age and body mass index(BMI) on perioperative bleeding during total knee arthroplasty from the perspective of patients’ own factors.To study the change in patients, systemic leukocyte count, IL-6 by the effect of tranexamic acid on the total knee arthroplasty reduce bleeding, at the same time to study the related indexes in patients with pain and pain related factors of prostaglandin E2,bradykinin concentration.Methods:Retrospective analysis of 210 patients with knee osteoarthritis in our hospital from December to January 2013 in our hospital, patients with knee osteoarthritis underwent unilateral knee replacement and 126 patients who met the criteria were selected.According to the past history and admission blood pressure divided into hypertension group and normal group, collecting clinical data of patients, according to Gross equation calculation peri operation period of total blood loss, observed blood loss and hidden blood loss, and study the influence of gender, age and BMI on blood loss.After application of tranexamic,we mede a prospective randomized controlled study to research patients with and without the use of tranexamic acid,the patients were included from June 2014 to June 2015 because the severe knee osteoarthritis underwent unilateral total knee arthroplasty in patients with brain stroke were randomly divided into tranexamic acid group and the control group, the clinical data were collected using Gross equation to calculate the amount of bleeding during the perioperative period,patients were observed the changes in white blood cell count in blood routine examination operation period, collecting patients before and after 6, 24, 48, 72 hours of peripheral venous blood circulation, after centrifugation, the upper plasma, using the method of ELISA determination peripheral blood circulating IL-6, bradykinin,prostaglandin E2 concentration, while to evateluate patients with perioperative pain by VAS score method and the amount of postoperative opioid medications used.Result:For patients receiving total knee arthroplasty, the total blood loss and hidden blood loss during perioperative period was significantly higher than that of the normal group,while the observed blood loss there was no significant difference between the two groups. Respectively hypertension group and normal group according to gender, age and BMI were further grouped study found that, in the normal group male bleeding volume was significantly higher than that in female, and for the hypertension group,male and female bleeding had no significant difference. The age factor in hypertension group and normal group had no obvious difference, and when the factors of age and BMI as a combination of factors to consider, in normal group in aged patients with obesity(> 70 years of age and BMI > 27kg/m2) in patients with peri operative bleeding was significantly increased, and in the hypertension group is difference was not statistically significant.The use of tranexamic acid can significantly reduce the total blood loss,observed and hidden blood loss in the perioperative period. At the same time, ammonia tranexamic acid groups of patients with postoperative 24 hours of white blood cell count, after 6 hours the concentration of IL-6 was significantly lower than that of the control group,and two groups of patients with postoperative bradykinin, prostaglandin E2 concentration, postoperative VAS scores and opioid dosage no statistical difference.Conclusion:Hypertension can be used as an independent risk factor for total knee arthroplasty perioperative bleeding had obvious effects for total knee arthroplasty with hypertension patients should moderate control of perioperative blood pressure.In addition to hypertension, gender, age and BMI can also have a significant impact on perioperative bleeding.Tranexamic acid in reducing total knee arthroplasty peri operative bleeding at the same time, can reduce the patients with local and systemic inflammatory response, which is favorable for the patients after recovery.