The Efficacy And Safety Of Tranexamic Acid Combined With Epinphrine In Total Knee Arthroplasty

Objective: To investigate the efficacy and safety of tranex amic acid(TXA)combined with epinephrine(EP)in total knee arth roplasty(TKA).Methods: Forty patients undergoing TKA at Xiangtan Central Hospital from January 2016 to February 2018 were selected as testing subjects.Patients were grouped according to the method of random number table.The different methods of TXA and EP were used as grouping conditions.The observation group: 1g TXA compatible saline 100 ml was intravenously injected 30 min before the surgery,and intraoperative catheter drainage catheter left behind the retrogr ade drainage tube was injected into the joint cavity using 2g TXA and 0.25 mg EP(1: 200,000)mixed and diluent to 50 ml.In the control group,1g TXA was intravenously injected to the observation group before the surgery,and the fascial indwelling drainage tube was closed during the operation.The posterior drainage tube was re trogradely injected into the joint cavity to 50 ml of 2 g TXA diluent.Both groups of drainage tubes were opened and drained after 2hours of the clamping.The total blood loss,dominant blood loss,and hidden blood loss were observed in the two groups.And the H emoglobin(HB),Hematocrit(HCT)and changed values were check ed at different time points before or after the surgery.And changes in value,the knee joint activity before and after surgery,surgery b efore and after the United States Special Surgery Hospital knee fun ctional score(HSS score),postoperative deep vein thrombosis and o ther indicators were also measured.The occurrence of adverse events were recorded.A subsequent visit for 1 month was followed to see if there was any venous thrombosis in the lower limbs.Results: 1 Effectiveness1.1 Blood loss and blood transfusion(rate): Compared with the control group,the total blood loss in the observation group,postope rative drainage,dominant blood loss,hidden blood loss significantly reduced(p < 0.05).There was no significant difference in the ratio of blood loss and total blood loss between the two groups(p > 0.05).The mean number of blood transfusion units in the observation group was lower than that in the control group,but there was no significant difference in blood transfusion volume and blood transfus ion rate(p > 0.05).1.2 Postoperative hemoglobin,hematocrit,and difference: Compared with the control group,the hemoglobin was increased on the first postoperative day in the observation group(p < 0.05),and the hemoglobin difference on the 1st,3rd,and 5th day after the operati on was observed.The difference in hematocrit between the first pos toperative day and the third postoperative day were significantly decreased(p < 0.05).1.3 Swelling rate and joint function: Compared with the control group,the difference between the operative and postoperative operative and shank circumferences in the observation group was significantly reduced(p < 0.05),and range of motion of the arthrodesis after surgery and scores of HSS after 1 week's surgery were significantly increased(p<0.05).2.Security aspects2.1 Postoperative blood pressure and heart rate: There was no significant difference in blood pressure and heart rate between the t wo groups at 6 h,12 h,24 h,and 48 h(p > 0.05).2.2 Positive rates and adverse events of deep venous thrombosis of the lower extremities: No deep venous thrombosis of the lower extremities was observed in both two groups.There was no persist ent hypertension,deep infection,and incision infection.There were one arrhythmia and one lung infection in the control group.There was one case of urinary tract infection in both groups.there wereno significant differences(p > 0.05).Conclusion: 1.TXA intraveno us injection combined with a certain amount of dosing of TXA plu s EP in TKA can effectively reduce postoperative hemorrhage,redu ce total blood loss after TKA,postoperative drainage,and hidden bl ood loss,further reducing the average Blood transfusion volume.2.The combined use of TXA and EP supplied with TXA alon e can further reduce knee joint swelling after TKA surgery and can obtain the better function for the early joint.3.The combined use of TXA and EP does not increase the incidence of deep venous thrombosis after TKA,does not form a large area of subcutaneous ecchymosis,however,it has little effect on the patient's blood pressure and heart rate along with the high safety.