| Objective:Effective reduction of perioperative blood loss is an important factor to improve the satisfaction and prognosis of patients undergoing total knee arthroplasty(TKA),and is also the key to enhanced recovery after surgery(ERAS).At present,some studies have shown that the use of tranexamic acid,tourniquet,elastic bandage pressure bandage,drainage tube clamping,knee flexion position fixation,cold compress therapy and other management can reduce TKA intraoperative and postoperative blood loss.However,the effect of SanQiZhiXue Decoction combined with the management of blood conservation has not been intensively investigated,to our knowledge.In this study,we evaluated whether the combined use of SanQiZhiXue Decoction could effectively reduce the perioperative blood loss and enhance the recovery of TKA compared with the simple application of basic treatment.Methods:According to strict standards,72 patients with knee osteoarthritis underwent unilateral total knee arthroplasty for the first time in the Dongguan Hospital of Traditional Chinese Medicine,from January 2018 to December 2018 were randomly divided into two groups.According to the visiting time,clinical cases were randomly divided into experimental group(basic treatment plus SanQiZhiXue Decoction)and control group(basic treatment)with 36 cases each.The two groups were treated with intra-articular and IV tranexamic acid.Tourniquet and electrocoagulation were used throughout the operation.Other measures such as elastic bandage pressure bandage,drainage tube clamping,knee flexion position fixation and cold compress therapy were maintained at an early stage after the surgery.The experimental group took SanQiZhiXue Decoction orally twice a day.It was taken one day before operation and not on the day of operation until the seventh day after operation.The primary outcome measures included total blood loss,dominant blood loss,hidden blood loss and transfusions.Secondary outcome measures included perioperative knee circumference,postoperative limb swelling rate,HSS score,operation time and length of hospital stay.The safety indexes included the incidence of venous thromboembolism,the change in D-Dimer level,alanine aminotransferase,aspartate aminotransferase and serum creatinine level.Results:In this study,63 cases completed totally.As 4 patients in the experimental group fell off,only 32 patients actually completed the study,while 5 patients in the control group fell off,only 31 patients actually completed the study.1.Baseline data:There was no significant difference in general data(including age,sex,height,weight,BMI,ASA score)and estimated blood volume between the two groups(P>0.05).2.Blood loss and transfusions:The mean calculated total blood loss was 857.05±223.33mL in the experimental group,of which the mean dominant blood loss was 333.59±37.38mL and the mean hidden blood loss was 528.46±207.40mL.The mean calculated total blood loss was 1007.33±234.09mL in the control group,of which the mean dominant blood loss was 347.90±31.11mL and the mean hidden blood loss was 665.88±220.17mL.The mean calculated total blood loss and hidden blood loss were significantly reduced(P<0.05)compared with control group.There was no significant difference between the two groups at dominant blood loss including intraoperative blood loss and wound drainage(P>0.05).There was no significant difference in homologous blood transfusion rate and transfusion value between the two groups(P>0.05).3.Postoperative extremity swelling:There was no significant difference in the circumference around knee joint between the two groups before the surgery,which was comparable.There was significant difference in knee joint circumference at each time point(P<0.05),indicating that the degree of extremity swelling in two groups varied with time points after the surgery,and the mean circumference of the experimental group was smaller than that of the control group.Besides,the postoperative limb swelling rates were significantly lower(P<0.05)in the experimental group on postoperative day 1,3,and7.4.HSS score,operation time and length of hospital stay:14 days after the surgery,the HSS score in the experimental group was 77.19±6.82 points,which were significantly enhanced(P<0.05)compared with the control group at 73.48±6.26 points.But no significant differences were observed in operation time and length of hospital stay between the two groups.5.The safety indexes:Within one month the surgery,DVT and PE did not occur in both groups.In this study,5 patients were found to have muscular calf vein thrombosis(MCVT),all of which occurred in the control group,significantly higher(P<0.05)than that of the experimental group.And the mean D-Dimer level in the experimental group was significantly lower(P<0.05)on postoperative day 1,3,and7,compared with the control group.There was no significant difference in ALT,AST and Cr level between the two groups before and after the surgery(P>0.05).Conelusion:SanQiZhiXue Decoction can effectively reduce the hidden blood loss and calculated total blood loss during the perioperative period of TKA.The combined application of tranexamic acid,tourniquet,elastic bandage pressure bandage,drainage tube clamping,knee flexion position fixation and cold compress treatment has no significantly changed on reducing the dominant blood loss and transfusions.However,SanQiZhiXue Decoction can effectively reduce the degree of extremity swelling after the surgery,thus increasing the enthusiasm of early walking exercise after TKA,helping to improve knee joint function and reduce the risk of venous thromboembolism,which is in line with ERAS. |
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