Objective To observe and compare the effects of intravenous versus topical application of tranexamic acid on blood loss and blood transfusion in elderly patients with total knee arthroplasty (TKA). Methods One hundred and twenty patients who received unilateral TKA in the Second Hospital of Bazhou City between Mar.2015 and Feb.2016 were enrolled in this study,and assigned to intravenous application group and topical application group,with 60 cases in each group.There were 53 males and 67 females, with age ranging from 60 to 83 years (mean,68.17 years).The patients in the topical application group were injected intra-articularly 0.5g tranexamic acid after closing articular cavity,and the patients in the intravenous application group were given 10mg/kg tranexamic acid by intravenous injection at 15 min before tourniquet pressure.The levels of Hb at before operation and postoperative 1d,3d,5d were observed and recorded.The levels of FIB,PT,APTT,D-D at before operation and postoperative 6h were observed and recorded.The intraoperative blood loss, flow amount postoperative 12h,total flow amount,hidden blood loss, total amount of blood loss and average amount of blood transfusion were compared between the two groups. Results The preoperative Hb levels had no difference between the two groups (P>0.05).The Hb level at postoperative 1d,3d,5d in topical application group was significantly higher than that in intravenous application group (P<0.05).The levels of FIB,PT,APTT before operation and postoperative 6h had no statistical significance (P>0.05);in the two groups.The D-D levels at postoperative 6h were higher than those of before operation in two groups,and the differences were statistically significant (P<0.05).The flow amount at postoperative 12h,total flow amount,total amount of blood loss and average amount of blood transfusion in topical application group were higher than those in intravenous application group,and the differences were statistically significant (P<0.05). Conclusion Compared with intravenous application of tranexamic acid,the topical application of tranexamic acid could significantly reduce the amount of postoperative blood loss and blood transfusion in elderly patients with TKA,and is conducive to the clinical rehabilitation of patients.%目的 观察和比较局部与静脉应用氨甲环酸对老年全膝关节置换术(total knee arthroplasty,TKA)失血量及输血量的影响.方法 选择2015年3月~2016年2月霸州市第二医院骨科行初次单侧TKA的120例老年患者,其中男性53例,女性67例;年龄 60~83岁,平均68.17 岁.随机数字表法分为局部应用组与静脉应用组,每组60例.局部应用组于关节腔关闭后在关节腔内注射氨甲环酸0.5g;静脉应用组在止血带加压前15min静脉内注射氨甲环酸10mg/kg.观察和记录术前及术后1、3、5d血红蛋白(Hb)水平以及术前和术后6h 纤维蛋白原(FIB)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)及D-二聚体(D-D)水平.比较两组术中失血量、术后12h 引流量、 总引流量、隐性失血量、总失血量和平均输血量.结果 两组术前Hb水平无明显差异(P>0.05),术后1、3、5d局部应用组Hb水平均明显高于静脉应用组(P<0.05);两组术前和术后6h FIB、PT、APTT比较差异无统计学意义(P>0.05),两组术后6h D-D水平高于术前,差异均有统计学意义(P<0.05);局部应用组术后12h引流量、术后总引流量、总失血量及平均输血量少于静脉应用组,差异比较均有统计学意义(P<0.05).结论 局部应用氨甲环酸较静脉应用能更有效地降低老年TKA患者的术后失血量及输血量,有利于患者的临床康复.
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