口服氨甲环酸的全膝关节置换术后引流与否的临床效果比较
Comparison of Clinical Effect of Oral Tranexamic Acid with or without Drainage after Total Knee Arthroplasty

目的：探讨围手术期口服氨甲环酸的初次单侧全膝关节置换术后是否放置引流的临床疗效及安全性。方法：选取2020年9月至2022年4月我院的60例符合纳入标准的患者，随机分为引流组(n = 30)与非引流组(n = 30)，由固定人员实施手术，麻醉前2 h及术后6 h、12 h分别口服氨甲环酸1 g，术中均不使用止血带。引流组在缝合切口前放置硅胶引流管，非引流组直接缝合伤口。所有患者均于术前1 d及术后第3 d检测红细胞、血红蛋白(Hb)，测量大小腿周径，记录总失血量、输血量、疼痛评分(VAS评分)，临时肌注止疼药物使用次数，住院天数，下地活动时间等，术前1 d及出院前1 d行患肢静脉血管彩超检查，详细记录上述数据并行统计学分析。结果：两组患者基础情况差异无统计学意义；疼痛评分(VAS评分)，临时肌注止疼药物使用次数，下地活动时间无统计学意义(P > 0.05)；非引流组大腿周径差及小腿周径差略高于引流组，但差异无统计学意义(P = 0.156; P = 0.054)；非引流组住院天数少于引流组，差异有统计学意义(P < 0.05)；非引流组总失血量、输血量及红细胞、血红蛋白丢失量低于引流组的总失血量、输血量及红细胞、血红蛋白丢失量，差异有统计学意义(P < 0.05)。两组患者术后均未出现下肢血栓，切口感染等严重并发症。结论：围手术期口服氨甲环酸的初次全膝关节置换术，不安置引流管可有效减少失血量，降低输血率，缩短恢复时间，同时不增加并发症，安全可行且有助于患者术后快速康复。
Objective: To investigate the clinical efficacy and safety of perioperative oral tranexamic acid drainage after primary unilateral total knee arthroplasty. Methods: 60 patients who met the inclu-sion criteria in our hospital from September 2020 to April 2022 were randomly divided into drain-age group (n = 30) and non drainage group (n = 30). The operation was performed by fixed person-nel. 1 g of tranexamic acid was taken orally 2 h before anesthesia and 6 h and 12 h after operation respectively. No tourniquet was used during operation. Silicone drainage tube was placed before suturing the incision in the drainage group, and the wound was sutured directly in the non drainage group. Red blood cells and hemoglobin (HB) were detected in all patients on the first day before operation and the third day after operation. The peripheral diameters of large and small legs were measured, and the total blood loss, blood transfusion, pain score (VAS score), the number of times of temporary intramuscular injection of painkillers, the length of hospital stay, and the time of going down to the ground were recorded. Color Doppler ultrasonography was performed on the veins of the affected limbs on the first day before operation and the first day before discharge. The above data were recorded in detail and statistically analyzed. Results: There was no significant difference in the basic situation between the two groups; There was no significant difference in pain score (VAS score), the number of times of temporary intramuscular injection of analgesic drugs and the time of underground activity (P > 0.05); The peripheral diameter difference of thigh and leg in non drain-age group was slightly higher than that in drainage group, but the difference was not statistically significant (P = 0.156; P = 0.054); The length of hospital stay in the non drainage group was less than that in the drainage group, the difference was