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[1]申震,韓文朝,王曉冰,等.氨甲環(huán)酸關(guān)節(jié)腔注射聯(lián)合三七散口服對(duì)初次全膝關(guān)節(jié)置換術(shù)圍手術(shù)期失血量的影響[J].中醫(yī)正骨,2017,29(10):40-43.
　SHEN Zhen,HAN Wenchao,WANG Xiaobing,et al.Effect of intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders on perioperative blood loss in patients who received primary total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(10):40-43.
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氨甲環(huán)酸關(guān)節(jié)腔注射聯(lián)合三七散口服對(duì)初次全膝關(guān)節(jié)置換術(shù)圍手術(shù)期失血量的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年10期
頁碼:
40-43
欄目:
臨床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Effect of intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders on perioperative blood loss in patients who received primary total knee arthroplasty
作者:
申震; 韓文朝; 王曉冰; 宋山峰; 李百華; 白宗堂; 魯素玲
河南省濮陽市中醫(yī)醫(yī)院,河南 濮陽 457000
Author(s):
SHEN Zhen; HAN Wenchao; WANG Xiaobing; SONG Shanfeng; LI Baihua; BAI Zongtang; LU Suling
Puyang Hospital of Traditional Chinese Medical,Puyang 457000,Henan,China
關(guān)鍵詞:
關(guān)節(jié)成形術(shù); 置換; 膝;  失血; 手術(shù);  圍手術(shù)期;  注射; 關(guān)節(jié)內(nèi);  氨甲環(huán)酸;  三七;  臨床試驗(yàn)
Keywords:
Key words arthroplasty; replacement; knee;  blood loss; surgical;  perioperative period;  injections; intra-articular;  tranexamic acid;  panax notoginseng;  clinical trial
摘要:
目的:觀察氨甲環(huán)酸關(guān)節(jié)腔注射聯(lián)合三七散口服對(duì)初次全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)圍手術(shù)期失血量的影響。方法:將302例初次接受TKA的患者隨機(jī)分為2組,151例采用氨甲環(huán)酸關(guān)節(jié)腔注射聯(lián)合三七散口服治療(聯(lián)合治療組),151例采用氨甲環(huán)酸關(guān)節(jié)腔注射聯(lián)合安慰劑口服治療(關(guān)節(jié)腔注射組)。TKA手術(shù)結(jié)束關(guān)閉關(guān)節(jié)腔后,向膝關(guān)節(jié)腔內(nèi)注射氨甲環(huán)酸注射液50 mL。術(shù)前3 d至術(shù)后14 d連續(xù)口服中藥配方顆粒三七散,每次4.5 g,每日2次。安慰劑應(yīng)用方法與三七散相同。術(shù)后14 d采用Gross方程計(jì)算患者的圍手術(shù)期失血量,測(cè)量患側(cè)與健側(cè)下肢周徑差值; 分別于術(shù)前3 d及術(shù)后1 d、7 d、14 d測(cè)量血漿D-二聚體含量。結(jié)果:術(shù)后14 d,聯(lián)合治療組的圍手術(shù)期失血量低于關(guān)節(jié)腔注射組[(453.41±61.31)mL,(502.92±46.91)mL,t=7.881,P=0.000]; 聯(lián)合治療組的患側(cè)與健側(cè)下肢周徑差值低于關(guān)節(jié)腔注射組[(0.62±0.12)cm,(0.75±0.22)cm,t=6.277,P=0.000]。手術(shù)前后不同時(shí)間點(diǎn)血漿D-二聚體含量比較,差異有統(tǒng)計(jì)學(xué)意義,存在時(shí)間效應(yīng)(F=238.157,P=0.000); 2組患者血漿D-二聚體含量總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(t=3.185,P=0.002); 術(shù)前3 d,2組患者血漿D-二聚體含量比較,差異無統(tǒng)計(jì)學(xué)意義[(0.35±0.15)ng·mL-1,(0.36±0.14)ng·mL-1,t=0.318,P=0.751]; 術(shù)后1 d、7 d、14 d時(shí),聯(lián)合治療組的血漿D-二聚體含量均低于關(guān)節(jié)腔注射組[(0.98±0.52)ng·mL-1,(1.15±0.87)ng·mL-1,t=2.048,P=0.041;(0.91±0.42)ng·mL-1,(1.34±0.56)ng·mL-1,t=7.601,P=0.000;(0.73±0.26)ng·mL-1,(0.95±0.47)ng·mL-1,t=5.289,P=0.000]; 時(shí)間因素和分組因素存在交互效應(yīng)(F=403.727,P=0.000)。結(jié)論:氨甲環(huán)酸關(guān)節(jié)腔注射聯(lián)合三七散口服可以減少初次TKA患者圍手術(shù)期失血量、減輕患肢腫脹程度、降低血漿D-二聚體含量,效果優(yōu)于單純氨甲環(huán)酸關(guān)節(jié)腔注射。
Abstract:
ABSTRACT Objective:To observe the effect of intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders on perioperative blood loss in patients who received primary total knee arthroplasty(TKA).Methods:Three hundred and two patients who received primary total TKA were randomly divided into 2 groups,one hundred and fifty-one patients were treated with intra-articular injection of tranexamic acid combined with oral application of panax notoginseng powders(combination treatment group),while the others were treated with intra-articular injection of tranexamic acid combined with oral application of placebo(intra-articular injection group).The tranexamic acid injection(50 ml)was injected into knee joint cavity after the articular cavity was closed at the end of the surgery.The panax notoginseng powders or the placebo were administered orally from preoperative day 3 to postoperative day 14,twice a day,4.5 g at a time.The perioperative blood loss was calculated by using Gross equation at postoperative day 14,and the difference between affected side and healthy side in lower limb circumference were measured,and the plasma D-dimer contents were measured at 3 days before the surgery and at 1,7 and 14 days after the surgery respectively.Results:At 14 days after the surgery,the perioperative blood loss was lower in combination treatment group compared to intra-articular injection group(453.41+/-61.31 vs 502.92+/-46.91 ml,t=7.881,P=0.000),and the difference between affected side and healthy side in lower limbs circumference was lower in combination treatment group compared to intra-articular injection group(0.62+/-0.12 vs 0.75+/-0.22 cm,t=6.277,P=0.000).There was statisticaldifference in the plasma D-dimer content between different timepoints before and after the surgery,in other words,there was time effect(F=238.157,P=0.000).There was statistical difference in the plasma D-dimer content between the 2 groups in general,in other words,there was group effect(t=3.185,P=0.002).There was no statistical difference in the plasma D-dimer content between the 2 groups at 3 days before the surgery(0.35+/-0.15 vs 0.36+/-0.14 ng/ml,t=0.318,P=0.751).The plasma D-dimer content was lower in combination treatment group compared to intra-articular injection group at 1,7 and 14 days after the surgery(0.98+/-0.52 vs 1.15+/-0.87 ng/ml,t=2.048,P=0.041; 0.91+/-0.42 vs 1.34+/-0.56 ng/ml,t=7.601,P=0.000; 0.73+/-0.26 vs 0.95+/-0.47 ng/ml,t=5.289,P=0.000).There was interaction between time factor and group factor(F=403.727,P=0.000).Conclusion:The combination therapy of intra-articular injection of tranexamic acid and oral application of panax notoginseng powders can reduce perioperative blood loss,affected limb swelling and plasma D-dimer contents in patients who received primary total TKA,and its curative effect is better than that of monotherapy of intra-articular injection of tranexamic acid.

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備注/Memo

備注/Memo:
基金項(xiàng)目:2015年濮陽市科技攻關(guān)項(xiàng)目(150625) 通訊作者:韓文朝 E-mail:[email protected]
更新日期/Last Update: 2018-03-10