[1]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].中华老年骨科与康复电子杂志,2019,(06):317-321.[doi:10.3877/cma.j.issn.2096-0263.2019.06.003]
　Kong Gang,Ma Weihua,Zhang Shudong.The effect on CRP after TKA which topically use tranexamic acid combine with glucocorticoid[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(06):317-321.[doi:10.3877/cma.j.issn.2096-0263.2019.06.003]
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氨甲环酸联合糖皮质激素局部使用对 TKA术后CRP的影响()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年06期
页码:
317-321
栏目:
关节
出版日期:
2019-12-05

文章信息/Info

Title:
The effect on CRP after TKA which topically use tranexamic acid combine with glucocorticoid
作者:
孔刚; 马卫华; 张树栋
264001 烟台市烟台山医院骨关节科
Author(s):
Kong Gang;  Ma Weihua;  Zhang Shudong
Department of Orthopaedics, Yantaishan Hospital, Yantai 264001, China Corresponding author: Ma Weihua, Email: mwhuacn@163.com
关键词:
关节成形术; 置换; 膝;  氨甲环酸;  糖皮质激素
Keywords:
Arthroplasty;  replacement;  knee;  Tranexamic;  Glucocorticoid
DOI:
10.3877/cma.j.issn.2096-0263.2019.06.003
文献标志码:
A
摘要:
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。
Abstract:
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.

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备注/Memo

备注/Memo:
基金项目：烟台市科技发展计划项目（2015WS056）
更新日期/Last Update: 2019-12-11