Study On The Effect Of Tranexamic Acid On Blood Loss,blood Transfusion Rate And Inflammatory Factors In Elderly Patients Undergoing Hip Replacement

Objective The main purpose of this study is to investigate the effect of tranexamic acid on the amount of blood loss and blood transfusion rate of the elderly patients undergoing hip replacement.The effect of tranexamic acid on the amount of blood loss and the rate of blood transfusion is studied in order to find out the best method of tranexamic acid in the hip replacement.Method From May 1,2016 to June 1,2017,60 cases of elderly patients with hip arthroplasty in Department of orthopedics,Huainan Chaoyang Hospital of Anhui were selected as the subjects.Single blind and random design tests were used.The subjects were divided into groups of A and B by random digital table.In group A,1.0g tranexamic acid was dissolved in 50 ml saline and injected around the joint cavity after the prosthesis was installed.Group B was given intravenous infusion of tranexamic acid 15mg/kg in 100 m L saline before cutting the skin.After the installation of the prosthesis,1.0g tranexamic acid was dissolved in 50 ml physiological saline and injected around the articular cavity.The total blood loss,dominant blood loss,recessive blood loss,postoperative flow rate and blood loss in the two groups were observed,and the blood transfusion was recorded during the operation.Two groups of peripheral venous blood were extracted from 48 h before and after operation,and the prothrombin time(PT)and partial thromboplastin were detected by the multi-function automatic biochemical analyzer.The content of(APTT)and D-dimer was measured by ester linked immunosorbent assay(ELISA).The expression of IL-6,IL-8,IL-10 and TNF-a in thetwo groups of peripheral blood before and after the treatment were detected.Results 1.Comparison of perioperative blood loss and transfusion rate between in two groups.The total blood transfusion volume,dominant blood loss,recessive blood loss and postoperative flow rate in group A were significantly higher than those in group B(P<0.05),but the difference of blood loss in the two groups was not statistically significant(P>0.05),and the blood transfusion rate(11/30)in group A was significantly higher than that in group B(2/30),and the difference was significantly higher than that of group B(2/30).It has statistical significance(X2=7.95,P<0.05).2.Comparison of blood clotting in the two and two groups before and after treatment.After 48 hours,PT,APTT,D-dimer and hs-CRP in group A were significantly higher than those in B group after operation(P<0.05).3.Two groups of patients before and after surgery serum levels of proinflammatory factors and the correlation with total blood loss.The results of peripheral blood ELISA showed that the TNF-a,IL-6,IL-8 and IL-10 in the two groups were significantly higher than those before the operation,and the difference was statistically significant(P<0.05).All the inflammatory factors in group B were significantly lower than those in the A group,and the difference was statistically significant(P<0.05).After Pearson correlation analysis,it was found that IL-10,IL-6,IL-8 and TNF-a were positively correlated with the blood loss(r IL-10=0.335,r IL-6=0.658,r IL-8=0.661,r TNF-ɑ=0.879,P<0.05).Conclusion 1.In this clinical study,the total amount of blood transfusion,the dominant blood loss,the recessive blood loss and the postoperative flow rate were significantly higher than those of the two routes of intralnal injection of tranexamic acid and intravenous and intra-articular injection of tranexamic acid.The blood loss after operation was better than intraarticular injection of tranexamic acid.2.After 48 hours PT,APTT,D-dimer and serum hs-CRP were significantly higher after intra-articularinjection of tranexamic acid,which was significantly higher than that of intravenous administration of tranexamic acid around the joint.Intravenous injection of tranexamic acid around the joint was beneficial to reduce 48 h hours PT,APTT,D-dimer and hsCRP level.3.According to the results of peripheral blood ELISA,the results of TNFalpha,IL-6,IL-8 and IL-10 in the two groups were significantly higher than those before the operation.All the inflammatory factors were significantly lower than those of the joint injection of tranexamic acid.IL-10,IL-6,IL-8 and TNF-a were positively correlated with the amount of blood loss.