切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 329 -334. doi: 10.3877/cma.j.issn.1674-134X.2019.03.012

所属专题： 文献；

荟萃研究

联合氨甲环酸和肾上腺素对全膝关节置换术失血的研究
王娟1, 丁岚利1, 廖茗伊1, 何泽艳1, 裴福兴2,†()   
  1. 1. 610041　成都，四川大学华西医院门诊部
    2. 610041　成都，四川大学华西医院骨科
  • 收稿日期:2018-12-10 出版日期:2019-06-01
  • 通信作者: 裴福兴

Combined tranexamic acid and diluted epinephrine reduces blood loss following primary total knee arthroplasty

Juan Wang1, Lanli Ding1, MingYi Liao1, Zeyan He1, Fuxing Pei2,†()   

  1. 1. Outpatient Department of West China Hospital, Sichuan University, Chengdu 610041, China
    2. Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China.
  • Received:2018-12-10 Published:2019-06-01
  • Corresponding author: Fuxing Pei
  • About author:
    Corresponding author: Pei Fuxing, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王娟, 丁岚利, 廖茗伊, 何泽艳, 裴福兴. 联合氨甲环酸和肾上腺素对全膝关节置换术失血的研究[J]. 中华关节外科杂志(电子版), 2019, 13(03): 329-334.

Juan Wang, Lanli Ding, MingYi Liao, Zeyan He, Fuxing Pei. Combined tranexamic acid and diluted epinephrine reduces blood loss following primary total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(03): 329-334.

目的

评价联合使用氨甲环酸(TXA)和稀释的肾上腺素(DEP)对初次全膝关节置换术(TKA)围术期失血量等指标的影响及其安全性。

方法

检索电子数据库包括PubMed，荷兰医学文摘数据库(EMBASE)，Cochrane对照研究注册中心，Web of Science，万方数据库和中国知网，根据纳入排除标准，包括初次TKA患者的随机对照研究，干预措施实验组为TXA＋DEP，对照组为TXA。采用RevMan 5.2软件进行Meta分析。

结果

经过全面严格筛选，共纳入高质量随机对照研究6篇。Meta分析结果显示，使用TXA＋DEP可以减少病人平均总失血量[MD ＝－184.32，95%CI(－251.11，－117.52), P<0.01]；平均减少隐性失血量[MD ＝－150.89，95%CI(－179.83，－121.95), P<0.00001]；平均减少引流量[MD ＝－63.16，95%CI(－116.29，－10.02), P＝0.02]。联合TXA＋DEP可以显著降低输血率[RR ＝0.51, 95%CI(0.28，0.93), P＝0. 03]；两组间深静脉血栓发生率差异无统计学意义(P＝1.00)。

结论

联合TXA＋DEP能有效减少初次TKA的失血量和降低输血率，并不增加术后DVT的发生率。

关键词: 氨甲环酸, 肾上腺素, 关节成形术，置换，膝, Meta分析
Objective

To evaluate the effect and safety of combination of tranexamic acid (TXA) and diluted-epinephrine (DEP) on blood loss during the primary total knee arthroplasty (TKA).

Methods

The electronic databases of PubMed, Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials, Web of Science, Wanfang and China National Knowledge Infrastructure (CNKI) were searched. TXA+ DEP were initially searched of the high-quality randomized controlled trials (RCTs) in TKA by the inclusion criteria, the intervention measures were as follows: the experimental group was TXA DEP, the control group was TXA. Meta-analysis was performed using RevMan 5.2 software.

Results

A total of six RCTs were included. The results of meta analysis showed that using TXA+ DEP could reduce the average total blood loss [MD =-184.32, 95%CI(-251.11, -117.52), P<0.01], reduce the average amount of hidden blood loss [MD =-150.89, 95%CI(-179.83, -121.95), P<0.00001], and reduce the average amount of drainage [MD =-63.16, 95%CI(-116.29, -10.02), P=0.02]. The combination application of TXA+ DEP could significantly reduce the blood transfusion rate [RR =0.51, 95%CI(0.28, 0.93), P=0. 03]. There was no significant difference in the incidence of DVT between the two groups (P=1.00).

Conclusion

Combination application of TXA+ DEP can effectively reduce the blood loss and transfusion rate in primary TKA, without increasing the incidence of DVT.

Key words: Tranexamic acid, Epinephrine, Arthroplasty, replacement, knee, Meta-analysis
表1 纳入研究的基本情况
作者 出版 时间 样本量(例) 年龄(岁) 干预措施 血栓预防 输血标准 随访 时间 改良 Jadad
TXA＋DEP组 TXA组 TXA＋DEP组 TXA组 TXA＋DEP组 TXA组
Gao et al [14] 2015 50 50 68.5 67.4 局部TXA 1 g ＋ DEP 0.25 mg 局部TXA 1 g 利伐沙班 Hb<80 g/L 90 d 7
Zeng et al [15] 2018 59 59 59.66 61.54 静脉10 mg/kg＋ 局部3 g TXA＋ DEP 0.25 mg 静脉10 mg/kg＋ 局部3 g TXA 低分子肝素 Hb<70 g/L 90 d 6
魏国[16] 2016 48 48 68.6 67 局部TXA 1 g＋ DEP 0.25 mg 局部TXA 1 g 低分子肝素 Hb<80 g/L 90 d 6
吴宏扬 [19] 2017 56 56 69.7 68.9 局部TXA 1 g＋ DEP 0.25 mg 局部TXA 1 g 低分子肝素 Hb<70 g/L 90 d 5
彭中鸿 [20] 2017 31 31 68.5 67.17 静脉TXA 10 mg/kg＋DEP 50 ml 静脉TXA 10 mg/kg － Hb<70 g/L 90 d 5
李海锋[21] 2017 32 32 66.21 66.21 局部TXA 3 g＋ DEP 0.25 mg 局部TXA 3 g － － 1 d 4
图1 总的失血量评估的出版偏倚
图2 总的失血量比较森林图
图3 隐性失血量比较森林图
图4 引流量比较森林图
图5 输血率比较森林图
图6 DVT(深静脉血栓)发生率比较森林图
[1]
Chaudhary R,Beaupré LA,Johnston DW. Knee range of motion during the first two years after use of posterior cruciate-stabilizing or posterior cruciate-retaining total knee prostheses. A randomized clinical trial[J]. J Bone Joint Surg Am, 2008, 90(12): 2579-2586.
[2]
Sarzaeem MM,Razi M,Kazemian G, et al. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty[J]. J Arthroplasty, 2014, 29(8): 1521-1524.
[3]
Demos HA,Lin ZX,Barfield WR, et al. Process improvement project using tranexamic acid is Cost-Effective in reducing blood loss and transfusions after total hip and total knee arthroplasty[J]. J Arthroplasty, 2017, 32(8): 2375-2380.
[4]
Nielsen CS,Jans Ø，Ørsnes T, et al. Combined Intra-Articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial[J]. J Bone Joint Surg Am, 2016, 98(10): 835-841.
[5]
Bong MR,Patel V,Chang E, et al. Risks associated with blood transfusion after total knee arthroplasty[J]. J Arthroplasty, 2004, 19(3): 281-287.
[6]
Gillet P,Rapaille A,Benoît A, et al. First-time whole blood donation: a critical step for donor safety and retention on first three donations[J]. Transfus Clin Biol, 2015, 22(5/6): 312-317.
[7]
Harsten A,Bandholm T,Kehlet H, et al. Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial[J]. Knee, 2015, 22(2): 126-130.
[8]
Wang S,Gao X,An Y. Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. Int Orthop, 2017, 41(4): 739-748.
[9]
Lee SY,Chong S,Balasubramanian D, et al. What is the ideal route of administration of tranexamic acid in TKA? A randomized controlled trial[J]. Clin Orthop Relat Res, 2017, 475(8): 1987-1996.
[10]
Poeran J,Rasul R,Suzuki S, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety[J]. BMJ, 2014, 349: g4829. doi: 10.1136/bmj.g4829.
[11]
Styron JF,Klika AK,Szubski CR, et al. Relative efficacy of tranexamic acid and preoperative anemia treatment for reducing transfusions in total joint arthroplasty[J]. Transfusion, 2017, 57(3): 622-629.
[12]
Patel JN,Spanyer JM,Smith LS, et al. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study[J]. J Arthroplasty, 2014, 29(8): 1528-1531.
[13]
Wind TC,Barfield WR,Moskal JT. The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty[J]. J Arthroplasty, 2013, 28(7): 1080-1083.
[14]
Gao FQ,Sun W,Guo WS, et al. Topical administration of tranexamic acid plus diluted-epinephrine in primary total knee arthroplasty: a randomized double-blinded controlled trial[J]. J Arthroplasty, 2015, 30(8): 1354-1358.
[15]
Zeng WN,Liu JL,Wang FY, et al. Low-dose epinephrine plus tranexamic acid reduces early postoperative blood loss and inflammatory response: a randomized controlled trial[J]. J Bone Joint Surg Am, 2018, 100(4): 295-304.
[16]
魏国，梁杰，李玉鹏，等．氨甲环酸联合肾上腺素减少单侧全膝关节置换术后出血的有效性及安全性研究[J]．中国全科医学，2016，19(3)：327-331.
[17]
Gasparini G,Papaleo P,Pola P, et al. Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty[J]. Int Orthop, 2006, 30(4): 253-256.
[18]
Yun-Choi HS,Park KM,Pyo MK. Epinephrine induced platelet aggregation in rat platelet-rich plasma[J]. Thromb Res, 2000, 100(6): 511-518.
[19]
吴宏扬，樊艳梅，杨建祥，等．术中关节腔注射氨甲环酸与肾上腺素对老年全膝关节置换术后出血的影响[J]．创伤外科杂志，2017，19(11)：840-843.
[20]
彭中鸿，刘劲松，李溪，等．氨甲环酸联合肾上腺素对全膝关节置换术失血量及膝关节功能恢复的影响[J]．昆明医科大学学报，2017，38(10)：83-89.
[21]
李海锋，袁晓伟，李成福，等．TKA后关节腔注入氨甲环酸与肾上腺素对患者出血及凝血功能的影响[J]．山东医药，2017，57(32)：68-70.
[22]
Pitta M,Zawadsky M,Verstraete R, et al. Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series[J]. Transfusion, 2016, 56(2): 466-471.
[23]
Anderson LA,Engel GM,Bruckner JD, et al. Reduced blood loss after total knee arthroplasty with local injection of bupivacaine and epinephrine[J]. J Knee Surg, 2009, 22(2): 130-136.
[1] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[2] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[3] 罗旺林, 杨传军, 许国星, 俞建国, 孙伟东, 颜文娟, 冯志. 开放性楔形胫骨高位截骨术不同植入材料的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 818-826.
[4] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[5] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[6] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[7] 李辉, 吴奇, 张子琦, 张晗, 王仿, 许鹏. 日间全膝关节置换术早期疗效及标准化流程探索[J]. 中华关节外科杂志(电子版), 2023, 17(06): 889-892.
[8] 李雄雄, 周灿, 徐婷, 任予, 尚进. 初诊导管原位癌伴微浸润腋窝淋巴结转移率的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 466-474.
[9] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[10] 武慧铭, 郭仁凯, 李辉宇. 机器人辅助下经自然腔道取标本手术治疗结直肠癌安全性和有效性的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(05): 395-400.
[11] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[12] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[13] 杨海龙, 邓满军, 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元. 腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 545-550.
[14] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
[15] 孙畅, 赵世刚, 白文婷. 脑卒中后认知障碍与内分泌激素变化的关系[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 471-476.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号