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[1]駱曉飛,魏瑄,王金良,等.氨甲環(huán)酸對全膝關(guān)節(jié)置換術(shù)中應(yīng)用止血帶造成的缺血再灌注損傷的影響[J].中醫(yī)正骨,2019,31(06):12-17.
　LUO Xiaofei,WEI Xuan,WANG Jinliang,et al.Effects of tranexamic acid on ischemia-reperfusion injury caused by application of tourniquet in the surgery of total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(06):12-17.
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氨甲環(huán)酸對全膝關(guān)節(jié)置換術(shù)中應(yīng)用止血帶造成的缺血再灌注損傷的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年06期
頁碼:
12-17
欄目:
臨床研究
出版日期:
2019-06-20

文章信息/Info

Title:
Effects of tranexamic acid on ischemia-reperfusion injury caused by application of tourniquet in the surgery of total knee arthroplasty
作者:
駱曉飛; 魏瑄; 王金良; 王少華
(鄭州市骨科醫(yī)院,河南 鄭州 450052)
Author(s):
LUO Xiaofei; WEI Xuan; WANG Jinliang; WANG Shaohua
Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
關(guān)節(jié)成形術(shù); 置換; 膝;  再灌注損傷;  止血帶;  氨甲環(huán)酸;  白細(xì)胞介素6;  腫瘤壞死因子α
Keywords:
arthroplasty; replacement; knee;  reperfusion injury;  tourniquets;  tranexamic acid;  interleukin-6;  tumor necrosis factor-alpha
摘要:
目的:探討氨甲環(huán)酸對全膝關(guān)節(jié)置換(total knee arthroplasty,TKA)術(shù)中應(yīng)用止血帶造成的缺血再灌注損傷的影響。方法:膝骨關(guān)節(jié)炎患者60例,男19例、女41例; 年齡61～79歲,中位數(shù)68歲; 病程3～20年,中位數(shù)8年。隨機(jī)分為氨甲環(huán)酸組和生理鹽水組,每組30例。均行初次單側(cè)全膝關(guān)節(jié)置換術(shù),手術(shù)全程上充氣止血帶,放置負(fù)壓引流管。分別于術(shù)中安裝假體后和術(shù)后3 h,氨甲環(huán)酸組給予氨甲環(huán)酸1 g加入100 mL生理鹽水中靜脈滴注,生理鹽水組給予生理鹽水100 mL靜脈滴注。術(shù)中縫合關(guān)節(jié)囊后,氨甲環(huán)酸組給予氨甲環(huán)酸1 g加入100 mL生理鹽水中關(guān)節(jié)腔局部灌注,生理鹽水組給予生理鹽水100 mL關(guān)節(jié)腔局部灌注。術(shù)后負(fù)壓引流管夾閉3 h后間斷開放,術(shù)后24 h拔除引流管。記錄2組患者手術(shù)時間、術(shù)中出血量及術(shù)后24 h負(fù)壓引流量。分別于術(shù)前、術(shù)后24 h、術(shù)后72 h時肘靜脈采血5 mL,術(shù)后24 h拔除引流管時取引流液10 mL。采用酶聯(lián)免疫法檢測外周血血清中和關(guān)節(jié)腔引流液中白細(xì)胞介素-6(interleukin-6,IL-6)、腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)含量。結(jié)果:①一般結(jié)果。2組患者均順利完成手術(shù),手術(shù)時間、術(shù)中出血量的組間差異均無統(tǒng)計(jì)學(xué)意義[(73.4±6.5)min,(70.2±8.2)min,t=1.636,P=0.326;(65±11)mL,(62±15)mL,t=0.824,P=0.428],氨甲環(huán)酸組術(shù)后24 h引流量少于生理鹽水組[(217±35)mL,(467±52)mL,t=21.710,P=0.000]。②2組患者手術(shù)前后外周血血清中IL-6含量檢測結(jié)果。時間因素和分組因素存在交互效應(yīng)(F=12.312,P=0.000); 2組患者外周血血清中IL-6含量的組間總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=3.214,P=0.001); 不同時間點(diǎn)間外周血血清中IL-6含量總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在時間效應(yīng)(F=16.531,P=0.000); 2組患者手術(shù)前后外周血血清中IL-6含量均呈先增高后降低的趨勢,但2組的趨勢不完全一致[氨甲環(huán)酸組:(6.23±1.65)pg·mL-1,(28.13±4.21)pg·mL-1,(22.09±2.75)pg·mL-1; 生理鹽水組:(6.41±2.02)pg·mL-1,(37.54±5.31)pg·mL-1,(32.52±3.01)pg·mL-1]; 術(shù)前2組患者外周血血清中IL-6含量的組間差異無統(tǒng)計(jì)學(xué)意義(t=1.567,P=0.268); 術(shù)后24 h和術(shù)后72 h時,氨甲環(huán)酸組患者外周血血清中IL-6含量均低于生理鹽水組(t=3.553,P=0.001; t=4.537,P=0.000)。③2組患者手術(shù)前后外周血血清中TNF-α含量檢測結(jié)果。時間因素和分組因素存在交互效應(yīng)(F=17.312,P=0.000); 2組患者外周血血清中TNF-α含量的組間總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=4.318,P=0.000); 不同時間點(diǎn)間外周血血清中TNF-α含量總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在時間效應(yīng)(F=15.231,P=0.000); 2組患者手術(shù)前后外周血血清中TNF-α含量均呈先增高后降低的趨勢,但2組的趨勢不完全一致[氨甲環(huán)酸組:(20.51±3.61)pg·mL-1,(35.33±4.35)pg·mL-1,(31.32±2.98)pg·mL-1; 生理鹽水組:(19.82±2.96)pg·mL-1,(42.85±3.87)pg·mL-1,(37.76±3.62)pg·mL-1]; 術(shù)前2組患者外周血血清中TNF-α含量的組間差異無統(tǒng)計(jì)學(xué)意義(t=1.312,P=0.316); 術(shù)后24 h和術(shù)后72 h時,氨甲環(huán)酸組患者外周血血清中TNF-α含量均低于生理鹽水組(t=5.124,P=0.000; t=3.317,P=0.001)。④2組患者術(shù)后關(guān)節(jié)腔引流液中IL-6、TNF-α含量檢測結(jié)果。氨甲環(huán)酸組術(shù)后關(guān)節(jié)腔引流液中IL-6、TNF-α含量均低于生理鹽水組[(30.23±3.42)pg·mL-1,(38.78±4.15)pg·mL-1,t=2.637,P=0.018;(31.65±4.27)pg·mL-1,(41.24±4.83)pg·mL-1,t=3.281,P=0.001]。結(jié)論:在TKA術(shù)中靜脈滴注結(jié)合關(guān)節(jié)腔灌注氨甲環(huán)酸,有利于減輕應(yīng)用止血帶造成的缺血再灌注損傷。
Abstract:
Objective:To explore the effects of tranexamic acid on ischemia-reperfusion injury caused by application of tourniquet in the surgery of total knee arthroplasty(TKA).Methods:Sixty patients with knee osteoarthritis(KOA)were randomly divided into tranexamic acid group and normal saline(NS)group,30 cases in each group.The patients consisted of 19 males and 41 females,and ranged in age from 61 to 79 years(Median=68 yrs)and in disease course from 3 to 20 years(Median=8 yrs).The primary unilateral TKA were performed on all patients in the 2 groups.A pneumatic tourniquet was used during the whole surgery and a negative-pressure drainage tube was placed before the incision was closed.The patients in tranexamic acid group were treated with intravenous drip of tranexamic acid(1 g)dissolved in 100 mL of NS,while the patients in NS group were treated with intravenous drip of 100 mL of NS after the prosthesis was installed in the surgery and at 3 hours after the surgery respectively.After the joint capsule was sutured in the surgery,the patients in tranexamic acid group were treated with intraarticular local perfusion with tranexamic acid(1 g)dissolved in 100 mL of NS,while the patients in NS group were treated with intraarticular local perfusion with 100 mL of NS.The negative-pressure drainage tube was closed for 3 hours and then was released intermittently.The drainage tube was removed at 24 hours after the surgery.The operative time,intraoperative blood loss and postoperative 24-hour negative-pressure drainage volume were recorded and compared between the 2 groups.The blood(5 mL)was fetched out from ulnar vein before the surgery and at 24 and 72 hours after the surgery respectively,and the drainage fluid(10 mL)was fetched when the drainage tube was removed at 24 hours after the surgery.The contents of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in peripheral blood serum and intra-articular drainage fluid were detected by using enzyme linked immunosorbent assays.Results:The surgeries were finished successfully in all patients.There was no statistical difference in operative time and intraoperative blood loss between the 2 groups(73.4+/-6.5 vs 70.2+/-8.2 min,t=1.636,P=0.326; 65+/-11 vs 62+/-15 mL,t=0.824,P=0.428).The postoperative 24-hour negative-pressure drainage volume was less in tranexamic acid group compared to NS group(217+/-35 vs 467+/-52 mL,t=21.710,P=0.000).There was interaction between time factor and group factor in contents of IL-6 in peripheral blood serum(F=12.312,P=0.000).There was statistical difference in the contents of IL-6 in peripheral blood serum between the 2 groups in general,in other words,there was group effect(F=3.214,P=0.001).There was statistical difference in the contents of IL-6 in peripheral blood serum between different timepoints,in other words,there was time effect(F=16.531,P=0.000).The contents of IL-6 in peripheral blood serum presented a time-dependent trend of increasing firstly and decreasing subsequently in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(tranexamic acid group:6.23+/-1.65,28.13+/-4.21,22.09+/-2.75 pg/mL; NS group:6.41+/-2.02,37.54+/-5.31,32.52+/-3.01 pg/mL).There was no statistical difference in the contents of IL-6 in peripheral blood serum between the 2 groups before the surgery(t=1.567,P=0.268).The contents of IL-6 in peripheral blood serum were lower in tranexamic acid group compared to NS group at 24 and 72 hours after the surgery(t=3.553,P=0.001; t=4.537,P=0.000).There was interaction between time factor and group factor in contents of TNF-α in peripheral blood serum(F=17.312,P=0.000).There was statistical difference in the contents of TNF-α in peripheral blood serum between the 2 groups in general,in other words,there was group effect(F=4.318,P=0.000).There was statistical difference in the contents of TNF-α in peripheral blood serum between different timepoints,in other words,there was time effect(F=15.231,P=0.000).The contents of TNF-α in peripheral blood serum presented a time-dependent trend of increasing firstly and decreasing subsequently in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(tranexamic acid group:20.51+/-3.61,35.33+/-4.35,31.32+/-2.98 pg/mL; NS group:19.82+/-2.96,42.85+/-3.87,37.76+/-3.62 pg/mL).There was no statistical difference in the contents of TNF-α in peripheral blood serum between the 2 groups before the surgery(t=1.312,P=0.316).The contents of TNF-α in peripheral blood serum were lower in tranexamic acid group compared to NS group at 24 and 72 hours after the surgery(t=5.124,P=0.000; t=3.317,P=0.001).The contents of IL-6 and TNF-α in postoperative intra-articular drainage fluid were lower in tranexamic acid group compared to NS group(30.23+/-3.42 vs 38.78+/-4.15 pg/mL,t=2.637,P=0.018; 31.65+/-4.27 vs 41.24+/-4.83 pg/mL,t=3.281,P=0.001).Conclusion:Intravenous drip of tranexamic acid and intraarticular perfusion with tranexamic acid are helpful for reducing the ischemia-reperfusion injury caused by application of tourniquet in the surgery of TKA.

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備注/Memo

備注/Memo:
基金項(xiàng)目:鄭州市科技發(fā)展計(jì)劃項(xiàng)目(20150138) 通訊作者:魏瑄 E-mail:[email protected](收稿日期:2019-03-16 本文編輯:楊雅)
更新日期/Last Update: 1900-01-01