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中华老年骨科与康复电子杂志 ›› 2019, Vol. 05 ›› Issue (06) : 317 -321. doi: 10.3877/cma.j.issn.2096-0263.2019.06.003

所属专题: 文献

关节

氨甲环酸联合糖皮质激素局部使用对TKA术后CRP的影响
孔刚1, 马卫华1,(), 张树栋1   
  1. 1. 264001 烟台市烟台山医院骨关节科
  • 收稿日期:2019-02-03 出版日期:2019-12-05
  • 通信作者: 马卫华
  • 基金资助:
    烟台市科技发展计划项目(2015WS056)

The effect on CRP after TKA which topically use tranexamic acid combine with glucocorticoid

Gang Kong1, Weihua Ma1,(), Shudong Zhang1   

  1. 1. Department of Orthopaedics, Yantaishan Hospital, Yantai 264001, China
  • Received:2019-02-03 Published:2019-12-05
  • Corresponding author: Weihua Ma
引用本文:

孔刚, 马卫华, 张树栋. 氨甲环酸联合糖皮质激素局部使用对TKA术后CRP的影响[J/OL]. 中华老年骨科与康复电子杂志, 2019, 05(06): 317-321.

Gang Kong, Weihua Ma, Shudong Zhang. The effect on CRP after TKA which topically use tranexamic acid combine with glucocorticoid[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2019, 05(06): 317-321.

目的

研究氨甲环酸联合糖皮质激素局部使用对单侧全膝关节置换术后C反应蛋白(CRP)的影响。

方法

前瞻性收集2016年10月至2017年7月,烟台市烟台山医院骨关节科拟行单侧全膝关节置换术的骨性关节炎患者120例,男性58例,女性62例;年龄56~78岁,平均年龄(67±10)岁;病程4~19年,平均病程(12±7)年。随机分为空白组,鸡尾酒组,氨甲环酸组,试验组。空白组30例,于术中紧密缝合关节囊后关节腔逆行注射生理盐水40 ml;鸡尾酒组30例,于术中注射"鸡尾酒"40 ml(生理盐水40 ml+罗哌卡因75 mg*3支+肾上腺素1 mg*1/4支+曲安奈德注射液40 mg*1支);氨甲环酸组30例,术中在紧密缝合关节囊后关节腔逆行注射氨甲环酸20 g/l(生理盐水40 ml+氨甲环酸0.5 g*2支10 ml);试验组30例,术中在紧密缝合关节囊后关节腔逆行注射氨甲环酸20 g/l(生理盐水40 ml+氨甲环酸0.5 g*2支10 ml)+注射"鸡尾酒"40 ml。四组术后均夹闭引流管4 h。于术后24 h抽取CRP检查,比较四组术前、术后及各组间CRP的变化情况。

结果

术前四组患者年龄、性别及BMI指数无统计学差异。术前各组患者CRP差异无统计学意义,术后各组CRP差异有统计学意义(F=49.887,P<0.001),两两比较示,试验组患者CRP明显低于空白组、鸡尾酒组及氨甲环酸组,氨甲环酸组低于空白组,而氨甲环酸组与鸡尾酒组、鸡尾酒组与空白组差异无统计学意义。

结论

氨甲环酸与糖皮质激素均有抗炎、降低炎症反应的作用。氨甲环酸联合糖皮质激素局部使用可以进一步有效降低全膝关节置换围手术期炎症反应,减少关节感染的发生。

Objective

To investigate the effect on CRP after unilateral total knee arthroplasty (TKA) which topically use tranexamic acid combine with glucocorticoid.

Methods

From October 2016 to July 2017, 120 patients suffered from osteoarthritis arthritis (OA) underwent unilateral total knee arthroplasty (TKA) were collected. There were 58 males and 62 females, age ranging from 56-78 (67±10) years, and the course of disease was 4-19 (12±7) years. They were randomly assigned to blank group, "cocktail" group, tranexamic group and experimental group. In the blank group of 30 cases, the physiological saline 40 ml was injected into the joint cavity after articular capsule were sutured closely during the operation. In the "cocktail" group, 30 cases were injected with "cocktail" 40 ml (physiological saline 40 ml+ropivacaine 75 mg *3+adrenaline 1 mg*1/4+triamcinolone acetonide). In the tranexamic group, 30 cases were injected with physiological saline 40 ml and tranexamic (physiological saline 40 ml+tranexamic 0.5 g*2) was injected into the joint cavity after articular capsule were sutured closely during the operation. In the experimental group, 30 cases were injected with "cocktail" 40 ml and tranexamic (physiological saline 40ml+tranexamic 0.5 g*2) was injected into the joint cavity after articular capsule were sutured closely during the operation. The four groups were closed drainage tube for 4 hours. C reactive protein was examined at 24 hours after operation.

Results

There was no significant difference in age, sex, BMI and CRP between the groups before operation(F=49.887, P<0.001). After the operation, the significant difference was found in CRP of four groups. To compare with each other, the CRP in the experimental group was significantly lower than that in the blank group, the "cocktail" group and the tranexamic group, the CRP in the tranexamic group was lower than that in the blank group. There was no significant difference between the tranexamic group and cocktail group, nor was there any difference between the cocktail group and the blank group.

Conclusions

Tranexamic acid and corticosteroids have anti-inflammatory and reduce inflammation. Tranexamic acid combined with glucocorticoid topical use can further reduce the total knee arthroplasty inflammation response during perioperative period, reduce the occurrence of joint infection.

图2 预制完毕的拟注射药物
图1 独立样本Kruskal-Wallis检验术后患者CRP明显低于其余三组
表1 全膝关节置换术患者术前四组患者年龄、性别及BMI指数比较
表2 全膝关节置换术患者术术前及术后患者C反应蛋白比较(mg/dl,±s
1
Bottner F, Wegner A, Winkelmann W, et al. Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement [J]. J Bone Joint Surg Br, 2007, 89(1): 94-99.
2
Yeh CC, Ho ST, Kong SS, et al. Absence of the preemptive analgesic effect of dextromethorphan in total knee replacement under epidural anesthesia [J]. Acta Anaesthesiol Sin, 2000, 38(4): 187-193.
3
Uesugi K, Kitano N. Kikuchi TComparison of peripheral nerve block with periarticular injection analgesia after total knee arthroplasty:a randomized,controlled study [J]. Knee, 2014, 21(4): 848-852.
4
Lei YT, Xie JW, Xu B, et al. The efficacy and safety of multiple-dose intravenous tranexamic acid on blood loss following total knee arthroplasty: a randomized controlled trial [J]. Int Orthop, 2017, 41(10): 2053-2059.
5
Graham EM, Atz AM. Gillis JDifferential effects of aprotinin and tranexamic acid on outcomes and cytokine profiles in neonates undergoing cardiac surgery [J]. J Thorac Cardiovasc Surg, 2012, 143(5): 1069-1076.
6
Leopold SS, Casnellie MT, Warme WJ, et al. Endogenous cortisol production in response to knee arthroscopy and total knee arthroplasty [J]. J Bone Joint Surg Am, 2003, 85A(11): 2163-2167.
7
Sean VW, Chin PL. Chia SLSingle-dose periarticular steroid infiltration for pain management in total knee arthroplasty:a prospective, double-blind,randomised controlled trial [J]. Singapore Med J, 2011, 52(1): 19-23.
8
Lei YT, Xu B, Xie XW, et al. The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial [J]. Int Orthop, 2018, 42(3): 499-505.
9
Xu B, Ma J, Huang Q, et al. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study [J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1549-1556.
10
Hartman J, Khanna V, Habib A, et al. Perioperative systemic glucocorticoids in total hip and knee arthroplasty: A systematic review of outcomes [J]. J Orthop, 2017, 14(2): 294-301.
11
Zhao X, Qin J, Tan Y, et al. Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis [J]. J Orthop Surg Res, 2015, 10: 75.
12
覃健,余存泰,徐中和,等.全髋关节及全膝关节置换术后隐性失血的临床影响[J].中华骨科杂志, 2006, 26(5): 323-326.
13
Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials [J]. Transfusion, 2005, 45(8): 1302-1307.
14
孟庆奇.不同氨甲环酸应用方式对初次单侧全髋关节置换术的止血效果、安全性及临床疗效的影响[J].中华骨与关节外科杂志, 2019, 12 (7): 524-527, 550.
15
尹玉玲. 2018年美国关节置换术使用氨甲环酸的临床实践指南解读[J].中华关节外科杂志(电子版), 2019, 13(1): 93-98.
16
Jules-Elysee KM, Tseng A, Sculco TP, et al. Comparison of Topical and Intravenous Tranexamic Acid for Total Knee Replacement: A Randomized Double-Blinded Controlled Study of Effects on Tranexamic Acid Levels and Thrombogenic and Inflammatory Marker Levels. [J]. J Bone Joint Surg Am, 2019, 20: [Epub ahead of print].
17
Wang D, Luo ZY, Yu ZP, et al. The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial [J]. J Thromb Haemost, 2018, 16(12): 2442-2453.
18
Yu Y, Lin H, Wu Z, et al. Perioperative combined administration of tranexamic acid and dexamethasone in total knee arthroplasty-benefit versus harm? [J]. Medicine, 2019, 98(34): e15852.
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