| ObjectiveTo analyze the effect of topical application of time of etranexamic acid on blood loss and coagulation after total hip arthroplastyMethodsA total of 120 patients undergoing primary total hip arthroplasty admitted from January 2017 to October 2017 in our hospital were divided into group Ⅰ,group Ⅱ,group Ⅲ and group Ⅳ according to the order of operation,30 in each group.At the end of the operation,after suturing the joint capsule,2.0g tranexamic acid was diluted in 20 ml normal saline before injection into the joint cavity,and tranexamic acid topical application time for 1 hour in group I.The group Ⅱ tranexamic acid topical application time is 2 hours;Ⅲ group tranexamic acid topical application time is 4 hours;Ⅳ group tranexamic acid topical application time is 6 hours.When the application timeof etranexamic acid is completed,suction to attract,within 48 hours after removal of the drainage tube,postoperative conventional foot pump,postoperative 12 hours low molecular weight heparin anticoagulant,after discharge from the hospital rivaroxaban Condensation to 35 days after surgery.Preo perative general information including age,sex,height,weight,preoperative hemagglutination index,hemoglobin(Hb),and hematocrit(HCT)were compared between the four groups.The postoperative Dominant blood volume,Implicit blood loss,blood transfusion,hemoglobin value and hematocrit value on the 1st,3rd,and 7th day postoperatively were compared between the four groups.The patients in the four groups were compared whether there were abnormal limb swelling and subcutaneous bleeding;The patients in the four groups were compared whether there were deep venous thrombosis and pulmonary embolism Clinical manifestations.ResultsThere were differences in sex,age,height,weight,etiology,body mass index,ASA,APTT,PT,FIB and operation time among the four groups of patients,which could be compared but not statistically significant(P﹥0.05).There was no significant difference in preoperative Hb / HCT between the four groups(P>0.05).On the first day after surgery,the Hb and HCT of the four groups showed a decreasing trend with significant difference between the groups(P<0.05);At the 7th days after operation,the Hb and HCT in all four groups showed an upward trend compared with that on the first postoperative day.The level of Hb and HCT increased significantly in group Ⅲ,with significant difference between groups(P<0.05).There were significant differences among the four groups in drainage volume after operation(P>0.05).Among them,the total amount of bleeding in group Ⅲ was significantly lower than that in other groups;Four groups of patients with significant differences in total blood loss,with statistical significance(P<0.05),There was significant difference between the four groups in the amount of latent hemorrhage(P<0.05).The level of occult bleeding in group Ⅲ was significantly lower than that in other groups.There was no significant difference between the four groups in the amount of intraoperative hemorrhage(P>0.05);There was no significant difference in the number of blood transfusions between the four groups,which was not statistically significant(P> 0.05).In the four groups,there were 4 cases of secondary swelling around the knife edge,5 cases of small pieces of ecchymosis and knife-edge pain in group Ⅳ,and local swelling after irradiation.The difference between groups was statistically significant(P< 0.05).There was no clinical manifestations of deep venous thrombosis and pulmonary embolism in the four groups.The lower extremity vascular color Doppler ultrasound examination was performed on the fifth day after operation.No deep venous thrombosis of lower extremity was found.No deep venous thrombosis and pulmonary embolism three months after follow-up.ConclusionTopical application of tranexamic acid after total hip arthroplasty,topical application of tranexamic acid for 4 hours to best hemostatic effect,can reduce blood loss without causing knife-edge complications,and does not increase the risk of deep venous thrombosis. |
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