目的 比较老年全膝关节置换术(total knee arthroplasty,TKA)患者氨甲环酸(tranexamic acid,TXA)不同给药途径的疗效.方法 选取我院 2021 年 2 月至 2024 年 2 月间收治的 114 例 TKA 患者.根据随机数字表法将患者分为 3 组,每组各 38 例.静脉滴注(intravenous drip,IV)TXA 1 g(IV 组)、关节腔内注射(intra-articular injection,IA)TXA 2 g(IA 组)和 IV TXA 1 g 联合 IA TXA 1 g(IV+IA 组).比较 3 组患者围术期指标、关节肿胀程度、疼痛视觉模拟评分(visual analogue scale,VAS)以及膝关节评分系统(Keen Society score,KSS).结果 IV+IA 组患者术中失血量、隐性失血量、引流液量、总输血人数和住院天数低于 IV 组和 IA 组患者(P<0.05);IV+IA 组并发症发生率低于 IV 组和 IA 组(13.2%vs.39.5%vs.36.8%,P=0.013);术后 1 天和 7 天 IV+IA 组患者凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、国际标准化比率(international normalized ratio,INR)、D-二聚体(D-dimer,D-D)和 C-反应蛋白(C-reactive protein,CRP)低于 IV 组和 IA 组患者,纤维蛋白原(fibrinogen,Fib)高于 IV 组和 IA 组患者(P<0.05).术后 3 天、14 天、1 个月和 3 个月 IV+IA 组患者膝关节肿胀低于IV 组和 IA 组患者(P<0.05);术后 3 天、14 天和 1 个月 IV+IA 组患者 VAS 评分低于 IV 组和 IA 组患者(P<0.05);术后 3 天、14 天、1 个月和 3 个月 IV+IA 组患者 KSS 高于 IV 组和 IA 组患者(P<0.05).结论 与IV 组和 IA 组相比,IV 联合 IA TXA 可以显著减少 TKA 患者术中和术后出血、输血和并发症风险,降低患者疼痛程度,加速患者膝关节功能的恢复,具有更好的疗效.
A study of the efficacy of different routes of administration of tranexamic acid in elderly patients undergoing knee arthroplasty
Objective To compare the efficacy of different routes of tranexamic acid(TXA)administration in elderly total knee arthroplasty(TKA)patients.Methods 114 TKA patients admitted to our hospital between February 2021 and February 2024 were selected.The patients were divided into 3 groups according to the random number table method with 38 cases in each group,including intravenous(IV)drip TXA 1 g group(IV group),intra-articular(IA)injection TXA 2 g group(IA group)and IV TXA 1 g combined with IA TXA 1 g group(IV+IA group).Perioperative indicators,joint swelling,visual analogue scale(VAS)of pain and Knee Society score(KSS)were compared among the three groups.Results Intraoperative blood loss,occult blood loss,drainage fluid volume,transfusion frequency and hospital day were lower for patients in the IV+IA group than those in the IV and IA group(P<0.05);the complication rate was lower in the IV+IA group than in the IV and IA groups(13.2%vs.39.5%vs.36.8%,P=0.013);the prothrombin time(PT),activated partial thromboplastin time(APTT),international normalised ratio(INR),D-dimer(D-D)and C-reactive protein(C-RP)of the IV+IA group were lower than those of patients in IV group and IA group,while the fibrinogen(Fib)was higher than those of patients in group IV and IA one and seven days postoperatively(P<0.05).Knee swelling was lower in patients in the IV+IA group than in patients in the IV and IA groups at 3 days,14 days,1 month,and 3 months after surgery(P<0.05).VAS was lower in patients in the IV+IA group than in patients in the IV and IA groups at 3 days,14 days,and 1 month after surgery(P<0.05).KSS was higher in patients in the IV+IA group than in patients in the IV and IA groups at 3 days,14 days,1 month,and 3 months after surgery(P<0.05).Conclusions Compared with IV and IA group,IV combined with IA TXA can significantly reduce intraoperative and postoperative bleeding,blood transfusion,pain and complications in patients with TKA,accelerating the recovery of knee function with better efficacy.
Arthroplasty,replacement,kneeTranexamic acidComparative effectiveness research
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