全髋关节置换局部应用氨甲环酸术中术后失血及白细胞介素6和C-反应蛋白的变化
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摘要
背景:多数研究是在全髋关节置换开始前将氨甲环酸静脉注射入患者体内,观察其对显性及隐形失血的影响,很少有研究观察氨甲环酸治疗后血液中白细胞介素6及C-反应蛋白的变化情况。目的:探讨氨甲环酸局部应用对全髋关节置换围置换期失血以及白细胞介素6和C-反应蛋白的影响。方法:选择2015年1月至2017年1月在青海红十字医院就诊行初次单侧全髋关节置换的75例患者作为研究对象,随机分为治疗组和对照组,治疗组37例在安置假体后给予氨甲环酸静脉点滴,对照组38例在相同时间给予等量的氯化钠静脉点滴。观察并比较2组患者术中失血量、术后引流量、总失血量、隐性出血量、输血量及输血率;测量2组患者术前及术后不同时刻的血红蛋白及红细胞压积、C-反应蛋白及白细胞介素6的表达水平;记录2组患者发热、下肢静脉血栓形成等并发症发生情况。结果与结论:(1)治疗组术后引流量、总出血量、隐性失血量、术后输血量及术后输血率均小于对照组,差异有显著性意义(P <0.05);(2)治疗组术后3 h、1 d、3 d、7 d的血红蛋白及红细胞压积均高于对照组,差异有显著性意义(P <0.05);(3)术后3 h、1 d及3 d时2组患者C-反应蛋白及白细胞介素6水平均逐渐升高,且对照组升高更多(P <0.05);(4)围置换期2组患者无发热、感染及下肢深静脉血栓形成;(5)提示静脉应用氨甲环酸能够安全有效的减少全髋关节置换后出血,且能够降低白细胞介素6及C-反应蛋白释放水平。
BACKGROUND: There are many studies addressing the effect of intravenous injection of tranexamic acid before total hip arthroplasty on the dominant and hidden blood loss. But its effects on the levels of interleukin-6 and C-reactive protein are rarely reported.OBJECTIVE: To investigate the effects of local application of tranexamic acid on the blood loss and levels of interleukin-6 and C-reactive protein in the perioperative period of total hip arthroplasty.METHODS: Seventy-five patients undergoing primary unilateral total hip arthroplasty at Qinghai Red Cross Hospital from January 2015 to January 2017 were enrolled. The patients were randomized into treatment group(n=37, intravenous injection of tranexamic acid after prosthesis placed) and control group(n=38, intravenous injection of the same volume of normal saline). The intraoperative blood loss,postoperative drainage volume, total blood loss, hidden blood loss, blood transfusion volume and transfusion rate were compared between two groups. The hemoglobin, hematocrit, the levels of C-reactive protein and interleukin-6 at baseline and different time points postoperatively were measured. The complications like fever or lower extremity venous thrombosis were recorded.RESULTS AND CONCLUSION:(1) The postoperative drainage volume, total blood loss, hidden blood loss, postoperative blood transfusion volume and blood transfusion rate in the treatment group were significantly lower than those in the control group(P < 0.05).(2) The hemoglobin and hematocrit in the treatment group were significantly higher than those in the control group at 3 hours, 1, 3 and 7 days postoperatively(P < 0.05).(3) At postoperative 3 hours, 1 and 3 days, the levels of C-reactive protein and interleukin-6 were gradually increased in both groups, especially the control group(P < 0.05).(4) No fever, infection, or deep venous thrombosis of the lower extremities was observed in both groups.(5) To conclude, intravenous injection of tranexamic acid can reduce the blood loss after total hip arthroplasty safely and effectively, and also can reduce the levels of C-reactive protein and interleukin-6.
BACKGROUND: There are many studies addressing the effect of intravenous injection of tranexamic acid before total hip arthroplasty on the dominant and hidden blood loss. But its effects on the levels of interleukin-6 and C-reactive protein are rarely reported.OBJECTIVE: To investigate the effects of local application of tranexamic acid on the blood loss and levels of interleukin-6 and C-reactive protein in the perioperative period of total hip arthroplasty.METHODS: Seventy-five patients undergoing primary unilateral total hip arthroplasty at Qinghai Red Cross Hospital from January 2015 to January 2017 were enrolled. The patients were randomized into treatment group(n=37, intravenous injection of tranexamic acid after prosthesis placed) and control group(n=38, intravenous injection of the same volume of normal saline). The intraoperative blood loss,postoperative drainage volume, total blood loss, hidden blood loss, blood transfusion volume and transfusion rate were compared between two groups. The hemoglobin, hematocrit, the levels of C-reactive protein and interleukin-6 at baseline and different time points postoperatively were measured. The complications like fever or lower extremity venous thrombosis were recorded.RESULTS AND CONCLUSION:(1) The postoperative drainage volume, total blood loss, hidden blood loss, postoperative blood transfusion volume and blood transfusion rate in the treatment group were significantly lower than those in the control group(P < 0.05).(2) The hemoglobin and hematocrit in the treatment group were significantly higher than those in the control group at 3 hours, 1, 3 and 7 days postoperatively(P < 0.05).(3) At postoperative 3 hours, 1 and 3 days, the levels of C-reactive protein and interleukin-6 were gradually increased in both groups, especially the control group(P < 0.05).(4) No fever, infection, or deep venous thrombosis of the lower extremities was observed in both groups.(5) To conclude, intravenous injection of tranexamic acid can reduce the blood loss after total hip arthroplasty safely and effectively, and also can reduce the levels of C-reactive protein and interleukin-6.
引文
[1]Honcharuk E,Kayiaros S,Rubin LE.The direct anterior approach for acetabular augmentation in primary total hip arthroplasty.Arthroplast Today.2017;4(1):33-39.
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[3]高维亮,侯延丽.全髋关节置换术后常见并发症的康复研究进展[J].颈腰痛杂志,2009,30(6):546-548.
[4]倪进荣,王立新,陈新军.氨甲环酸的不同给药方式对减少初次全髋关节置换术后隐性出血的病例对照研究[J].中国骨伤,2016,29(8):713-717.
[5]杨宇翔,肖杰,马翅,等.氨甲环酸在全髋关节置换术中应用研究进展[J].创伤与急危重病医学,2017,5(3):152-156.
[6]周振宇.髋膝关节置换术后假体周围感染预防和治疗的相关研究[D].苏州:苏州大学,2016.
[7]Azam MQ,Sadat-Ali M.Quality of Life in Sickle Cell Patients After Cementless Total Hip Arthroplasty.J Arthroplasty.2016;31(11):2536-2541.
[8]李晋阳.探讨患者发生输血不良反应的相关因素分析[J].世界最新医学信息文摘,2018,18(1):71-72.
[9]袁磊,包倪荣,赵建宁.髋关节置换术后隐性失血的新进展[J].中国骨伤,2015,28(4):378-382.
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[11]闵令田,翁文杰,邱勇,等.关节腔内灌注氨甲环酸降低全膝关节置换手术出血的前瞻性随机对照研究[J].中华关节外科杂志(电子版),2014,8(4):52-55.
[12]张松,张涛,杨建文,等.氨甲环酸减少2型糖尿病患者全膝关节置换出血的安全性及有效性[J].中国组织工程研究,2017,21(11):1681-1687.
[13]Yi Z,Bin S,Jing Y,et al.Tranexamic acid administration in primary total hip arthroplasty:a randomized controlled trial of intravenous combined with topical versus single-dose intravenous administration.JBJS.2016;98(12),983-991.
[14]Nadler SB,Hidalgo J H,Bloch T.Prediction of blood volume in normal human adults.Surg.1962;51(2):224-232.
[15]Gross JB.Estimating allowable blood loss:corrected for dilution.Anesthesiology.1983;58(3):277-280.
[16]林庆波.全髋关节置换与空心螺钉置入内固定修复中老年股骨颈骨折:髋关节功能比较[J].中国组织工程研究,2015,19(35):5583-5587.
[17]Woon CYL,Moretti VM,Schwartz BE,et al.Total Hip Arthroplasty and Hemiarthroplasty:US National Trends in the Treatment of Femoral Neck Fractures.Am J Orthop(Belle Mead,NJ).2017;46(6):E474-E478.
[18]高宏梁,黄胜,吴锋锋,等.关节腔注射氨甲环酸对高龄人工股骨头置换术后失血的影响[J].中国老年学,2017,37(2):480-481.
[19]吕焕然,周勇,宋翔,等.氨甲环酸在体外循环冠状动脉旁路移植术中的血液保护作用及术后5年随访[J].中国分子心脏病学杂志,2017,17(5):2232-2235.
[20]陈祯,李坤河,郭隽英,等.不同剂量氨甲环酸对肝移植术中纤溶功能的影响[J].实用医学杂志,2015,31(17):2877-2880.
[21]王叙德,刘华高,方有智,等.氨甲环酸对肝癌患者肝切除手术出血量及术后凝血功能的影响[J].中国临床药理学杂志,2017,33(23):2351-2353.
[22]卢永伟,王银海,顾连华.氨甲环酸应用于股骨粗隆间骨折围手术期的临床疗效评价[J].中国生化药物杂志,2017,37(4):268-270.
[23]李辉,马建兵,陈信林,等.氨甲环酸降低股骨粗隆间骨折PFNA术后失血量的临床研究[J].实用骨科杂志,2016,22(11):973-975.
[24]刘金望,林炎水,蒋涛,向登.氨甲环酸对老年陈旧性股骨颈骨折伴骨质疏松行髋关节置换术失血的影响[J].中国老年学杂志,2017,37(1):148-150.
[25]刘峰,刘保一,赵德伟.氨甲环酸在全髋关节置换中应用方法的临床研究[J].实用骨科杂志,2017,23(12):1086-1090.
[26]王光辉,杨伟宇,王磊.氨甲环酸对单侧全髋关节置换术隐性失血的影响分析[J].中国伤残医学,2017,25(21):53-54.
[27]张成欢,刘云,赵建宁,等.静脉滴注联合局部应用氨甲环酸可减少全髋关节置换后隐性失血[J].中国组织工程研究,2015,19(44):7071-7076.
[28]蔡安烈,曾伟,袁朝晖,等.氨甲环酸对全髋关节置换术患者手术失血量及D-二聚体的影响[J].中国综合临床,2017,33(1):11-14.
[29]Syrovets T,Jendrach M,Rohwedder A,et al.Plasmin-induced expression of cytokines and tissue factor in human monocytes involves AP-1 and IKKbeta-mediated NF-kappaBactivation.Blood.2001;97(12):3941-3950.
[2]翟锋,刘芳.腰硬联合麻醉和全麻用于髋关节置换术的临床疗效观察[J].实用中西医结合临床,2018,18(2):23-25.
[3]高维亮,侯延丽.全髋关节置换术后常见并发症的康复研究进展[J].颈腰痛杂志,2009,30(6):546-548.
[4]倪进荣,王立新,陈新军.氨甲环酸的不同给药方式对减少初次全髋关节置换术后隐性出血的病例对照研究[J].中国骨伤,2016,29(8):713-717.
[5]杨宇翔,肖杰,马翅,等.氨甲环酸在全髋关节置换术中应用研究进展[J].创伤与急危重病医学,2017,5(3):152-156.
[6]周振宇.髋膝关节置换术后假体周围感染预防和治疗的相关研究[D].苏州:苏州大学,2016.
[7]Azam MQ,Sadat-Ali M.Quality of Life in Sickle Cell Patients After Cementless Total Hip Arthroplasty.J Arthroplasty.2016;31(11):2536-2541.
[8]李晋阳.探讨患者发生输血不良反应的相关因素分析[J].世界最新医学信息文摘,2018,18(1):71-72.
[9]袁磊,包倪荣,赵建宁.髋关节置换术后隐性失血的新进展[J].中国骨伤,2015,28(4):378-382.
[10]Xie J,Hu Q,Ma J,et al.Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty:a randomised clinical trial.Bone Joint J.2017;99-B(11):1442-1449.
[11]闵令田,翁文杰,邱勇,等.关节腔内灌注氨甲环酸降低全膝关节置换手术出血的前瞻性随机对照研究[J].中华关节外科杂志(电子版),2014,8(4):52-55.
[12]张松,张涛,杨建文,等.氨甲环酸减少2型糖尿病患者全膝关节置换出血的安全性及有效性[J].中国组织工程研究,2017,21(11):1681-1687.
[13]Yi Z,Bin S,Jing Y,et al.Tranexamic acid administration in primary total hip arthroplasty:a randomized controlled trial of intravenous combined with topical versus single-dose intravenous administration.JBJS.2016;98(12),983-991.
[14]Nadler SB,Hidalgo J H,Bloch T.Prediction of blood volume in normal human adults.Surg.1962;51(2):224-232.
[15]Gross JB.Estimating allowable blood loss:corrected for dilution.Anesthesiology.1983;58(3):277-280.
[16]林庆波.全髋关节置换与空心螺钉置入内固定修复中老年股骨颈骨折:髋关节功能比较[J].中国组织工程研究,2015,19(35):5583-5587.
[17]Woon CYL,Moretti VM,Schwartz BE,et al.Total Hip Arthroplasty and Hemiarthroplasty:US National Trends in the Treatment of Femoral Neck Fractures.Am J Orthop(Belle Mead,NJ).2017;46(6):E474-E478.
[18]高宏梁,黄胜,吴锋锋,等.关节腔注射氨甲环酸对高龄人工股骨头置换术后失血的影响[J].中国老年学,2017,37(2):480-481.
[19]吕焕然,周勇,宋翔,等.氨甲环酸在体外循环冠状动脉旁路移植术中的血液保护作用及术后5年随访[J].中国分子心脏病学杂志,2017,17(5):2232-2235.
[20]陈祯,李坤河,郭隽英,等.不同剂量氨甲环酸对肝移植术中纤溶功能的影响[J].实用医学杂志,2015,31(17):2877-2880.
[21]王叙德,刘华高,方有智,等.氨甲环酸对肝癌患者肝切除手术出血量及术后凝血功能的影响[J].中国临床药理学杂志,2017,33(23):2351-2353.
[22]卢永伟,王银海,顾连华.氨甲环酸应用于股骨粗隆间骨折围手术期的临床疗效评价[J].中国生化药物杂志,2017,37(4):268-270.
[23]李辉,马建兵,陈信林,等.氨甲环酸降低股骨粗隆间骨折PFNA术后失血量的临床研究[J].实用骨科杂志,2016,22(11):973-975.
[24]刘金望,林炎水,蒋涛,向登.氨甲环酸对老年陈旧性股骨颈骨折伴骨质疏松行髋关节置换术失血的影响[J].中国老年学杂志,2017,37(1):148-150.
[25]刘峰,刘保一,赵德伟.氨甲环酸在全髋关节置换中应用方法的临床研究[J].实用骨科杂志,2017,23(12):1086-1090.
[26]王光辉,杨伟宇,王磊.氨甲环酸对单侧全髋关节置换术隐性失血的影响分析[J].中国伤残医学,2017,25(21):53-54.
[27]张成欢,刘云,赵建宁,等.静脉滴注联合局部应用氨甲环酸可减少全髋关节置换后隐性失血[J].中国组织工程研究,2015,19(44):7071-7076.
[28]蔡安烈,曾伟,袁朝晖,等.氨甲环酸对全髋关节置换术患者手术失血量及D-二聚体的影响[J].中国综合临床,2017,33(1):11-14.
[29]Syrovets T,Jendrach M,Rohwedder A,et al.Plasmin-induced expression of cytokines and tissue factor in human monocytes involves AP-1 and IKKbeta-mediated NF-kappaBactivation.Blood.2001;97(12):3941-3950.