关节内注射氨甲环酸对关节镜下肩袖修补术后总失血量和术后疼痛的影响

Effect of Intra-Articular Injection of Tranexamic Acid on Total Blood Loss and Postoperative Pain after Arthroscopic Rotator Cuff Repair

摘要: 目的：探讨氨甲环酸在肩袖损伤围术期的临床有效性。方法：回顾性分析2023年1月至12月新疆医科大学第六附属医院运动医学科收治的60例肩袖损伤患者，按是否使用氨甲环酸分为对照组(30例)和治疗组(30例)。治疗组在关节镜探查后向关节腔注射1 g氨甲环酸生理盐水溶液，对照组给予等量安慰剂。比较两组术前及术后24 h、72 h总失血量(基于血红蛋白动态监测)、血清总蛋白、白蛋白及铁代谢指标，并统计分析血常规参数变化。结果：① 术前资料：术前两组患者的年龄、性别构成、体质量指数、高血压、糖尿病、手术时间以及血红蛋白、血小板、红细胞平均体积、平均血红蛋白浓度、血清总蛋白和白蛋白指标进行比较，差异均无显著性意义(P > 0.05) ② 血红蛋白水平在术后第5天治疗组(108.22 ± 19.32 vs. 101.32 ± 15.90, t = 1.611, P = 0.111)虽未达统计学显著，但呈现升高趋势；治疗组术后第5天白蛋白(36.83 ± 4.89 vs. 33.91 ± 3.69, t = 2.817, P = 0.006)及治疗组在术后第5天营养储备(白蛋白)及红细胞动态(计数、血红蛋白)方面表现优于对照组，可能反映其治疗效果对造血功能及营养状态的积极影响。结论：结果表明，治疗组在肩关节镜下肩袖修补术中应用的止血效果比较明显，因此在肩关节镜下肩袖修补术中作者建议首选氨甲环酸作为止血药物。

Abstract: Objective: To investigate the clinical efficacy of tranexamic acid in perioperative management of rotator cuff injuries. Methods: A retrospective analysis was performed on 60 patients with rotator cuff tears who underwent arthroscopic repair at the Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, between January 2023 and December 2023. Patients were divided into a control group (30 cases) receiving standard surgery alone and a treatment group (30 cases) receiving additional intra-articular injection of tranexamic acid. The control group underwent arthroscopic rotator cuff repair, while the treatment group received intra-articular injection of 1 g tranexamic acid combined with surgery. The total blood loss (based on dynamic monitoring of hemoglobin), serum total protein, albumin and iron metabolism indexes before and 24 h and 72 h after surgery were compared, and the changes of hematological parameters were statistically analyzed. Results: ① Preoperative data: compare the age, sex composition, body mass index, hypertension, diabetes, operation time, mean volume of hemoglobin, platelet, red blood cells, mean hemoglobin concentration, and total serum protein and albumin index of the two groups before surgery, No significant difference (P > 0.05). ② Hemoglobin level in the treatment group on postoperative day 5 (108.22 ± 19.32 vs. 101.32 ± 15.90, t = 1.611, P = 0.111), although not statistically significant, but it shows an upward trend; Albumin on postoperative day 5 of the treatment group (36.83 ± 4.89 vs. 33.91 ± 3.69, t = 2.817, P = 0.006) and the treatment group outperformed the control group in terms of nutritional reserve (albumin) and red blood cell dynamics (count, hemoglobin), It may reflect the positive effect of its therapeutic effect on hematopoietic function and nutritional status. Conclusion: The treatment group showed significantly better hemostatic effects in arthroscopic rotator cuff repair compared to the control group. Therefore, tranexamic acid is recommended as the preferred hemostatic drug for arthroscopic rotator cuff repair surgery.