氨甲环酸联合利伐沙班对单侧全膝关节置换术后患者出血量、凝血功能以及膝关节功能的影响

目的:探讨氨甲环酸联合利伐沙班对单侧全膝关节置换术后患者出血量、凝血功能及膝关节功能的影响。方法:选取2015年1月-2016年1月在解放军425医院骨科初次行单侧全膝关节置换术的患者66例为研究对象,按照随机数字表法分为治疗组与对照组,每组各33例。治疗组患者在止血带释放前向关节腔内注射氨甲环酸,对照组患者则给予氯化钠注射液进行静脉滴注,在术后6-12h内两组患者均口服利伐沙班。记录并对比两组患者总失血量、隐性出血量、输血率、输血量,对比两组患者手术前后凝血功能指标、膝关节功能评分、膝关节活动度、疼痛视觉模拟评分(VAS),并观察两组患者并发症发生情况。结果:与对照组对比,治疗组患者的总失血量、隐性出血量、输血量及输血率均明显降低(P0.05);治疗组与对照组患者术前与术后3 d的活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FG)水平比较均无显著差异(P0.05);术前两组患者的美国膝关节协会评分(AKSS)及膝关节活动度比较无显著差异(P0.05),术后7 d,治疗组与对照组患者的AKSS评分及膝关节活动度均较术前升高(P0.05),且治疗组患者的AKSS评分及膝关节活动度高于同时期对照组(P0.05);术前两组VAS评分比较无显著差异(P0.05),术后1 d,两组患者的VAS评分比较及与同组术前比较均无显著差异(P0.05),术后7 d,两组患者的VAS评分明显较术前及术后1 d降低(P0.05),但两组之间比较无显著差异(P0.05)。两组患者并发症总发生率对比无显著差异(P0.05)。结论:氨甲环酸联合利伐沙班可有效降低行单侧全膝关节置换术患者的出血量,加快关节功能的恢复,且不影响患者的凝血功能,值得临床推广。

Effect of Tranexamic Acid Combined Rivaroxaban in Bleeding Volume,Coagulation Function, Knee Function in Patients with Unilateral Total Knee Arthroplasty

ABSTRACT Objective: To investigate effect of tranexamic acid combined rivaroxaban in bleeding volume, coagulation function, knee function in patients with unilateral total knee arthroplasty. Methods: 66 patients who were underwent unilateral total knee replace- ment in department of orthopedics, PLA 425 hospital from January 2015 to January 2016 were selected as the subjects, and they were di- vided into treatment group and control group according to random number table method with 33 cases in each group. Patients in the treat- ment group were injected tranexamic acid in articular cavity before the tourniquet released, patients in the control group were given in- travenous drip of sodium chloride injection, and within 6-12 h after operation, patients in both groups were treated with oral rivaroxaban.The total blood loss, occult bleeding volume, blood transfusion rate and blood transfusion volume were recorded and compared between the two groups, the blood coagulation function index, knee function score, knee mobility and visual analogue scale (VAS) were com- pared between the two groups before and after operation, and the complications of the two groups were observed. Results: Compared with the control group, the total blood loss, occult bleeding volume, blood transfusion and blood transfusion rate of patients in the treat- ment group were significantly decreased (P<0.05). There was no significant difference in activation, partial thromboplastin time (APTT),prothrombin time (PT) and fibrinogen (FG) levels between the treatment group and the control group before and 3d after operation(P>0.05). There was no significant difference in the American Knee Society score (AKSS) and knee joint activity between the two groups be- fore operation(P>0.05), 7 d after operation, AKSS score and knee joint activity of patients in the treatment group and the control group were significantly higher (P<0.05), and AKSS score and knee joint activity of patients in the treatment group were significantly higher than in the control group(P<0.05). There was no significant difference in visual analogue scale (VAS) between the two groups before op- eration (P>0.05), 1 d after operation, VAS scores in the two groups were not significantly different, and compared with before operation (P>0.05), 7 d after operation, the VAS score of two groups was decreased compared with before and 1 d after operation(P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference in the total incidence of compli- cations between the two groups(P>0.05). Conclusion: Tranexamic acid combined with rivaroxaban can effectively reduce bleeding in pa- tients underwent unilateral total knee arthroplasty, accelerate the recovery of joint function, and it does not affect the coagulation function of patients, which is worthy of clinical promotion.