加味歸脾湯聯(lián)合氨甲環(huán)酸治療全膝關(guān)節(jié)置換術(shù)后隱性失血的臨床療效觀察摘要：

目的：評(píng)估加味歸脾湯聯(lián)合氨甲環(huán)酸治療全膝關(guān)節(jié)置換術(shù)后隱性失血的療效。

方法：選取2019年1月至2021年1月間行全膝關(guān)節(jié)置換術(shù)的患者，其中隱性失血≥200mL，分為治療組（接受加味歸脾湯聯(lián)合氨甲環(huán)酸治療）和對(duì)照組（單純接受輸液治療），比較兩組臨床療效并統(tǒng)計(jì)不良反應(yīng)發(fā)生情況。

結(jié)果：治療組50例，對(duì)照組50例。治療組患者的出血量、失血率、囊液量、術(shù)后住院時(shí)間和總費(fèi)用均顯著低于對(duì)照組（P<0.05）。兩組不良反應(yīng)發(fā)生率無顯著差異。

結(jié)論：加味歸脾湯聯(lián)合氨甲環(huán)酸治療全膝關(guān)節(jié)置換術(shù)后隱性失血可有效減少出血量和失血率，縮短住院時(shí)間并降低總費(fèi)用。治療安全性高，值得推廣應(yīng)用。

關(guān)鍵詞：加味歸脾湯；氨甲環(huán)酸；全膝關(guān)節(jié)置換術(shù)；隱性失血；療效觀察

Abstract:

Objective:ToevaluatetheclinicaleffectofGuipidecoctioncombinedwithtranexamicacidinthetreatmentofoccultbloodlossaftertotalkneearthroplasty.

Methods:PatientswhounderwenttotalkneearthroplastybetweenJanuary2019andJanuary2021wereselected.Thosewithoccultbloodloss≥200mLweredividedintothetreatmentgroup(receivedGuipidecoctioncombinedwithtranexamicacidtreatment)andthecontrolgroup(receivedsimpleinfusiontreatment).Theclinicaleffectsofthetwogroupswerecomparedandtheincidenceofadversereactionswasrecorded.

Results:Therewere50casesinthetreatmentgroupand50casesinthecontrolgroup.Theamountofbleeding,bloodlossrate,effusionvolume,lengthofhospitalstay,andtotalcostofthetreatmentgroupweresignificantlylowerthanthoseofthecontrolgroup(P<0.05).Therewasnosignificantdifferenceintheincidenceofadversereactionsbetweenthetwogroups.

Conclusion:Guipidecoctioncombinedwithtranexamicacidcaneffectivelyreducetheamountofbleedingandbloodlossrateaftertotalkneearthroplasty,shortenhospitalstays,andreducetotalcosts.Thetreatmentissafeandworthpromoting.

Keywords:Guipidecoction;Tranexamicacid;Totalkneearthroplasty;Occultbloodloss;ClinicaleffectobservatioIntroduction:

Totalkneearthroplasty(TKA)isacommonsurgicalprocedurefortreatingend-stagekneeosteoarthritis.However,itisoftenassociatedwithsignificantbloodloss,whichcanleadtopostoperativeanemia,transfusionrequirements,andprolongedhospitalization.TheroutineuseoftranexamicacidhasbeenshowntoeffectivelyreducebloodlossinTKA.Guipidecoction,atraditionalChinesemedicineformula,hasbeenusedtotonifyqiandnourishbloodforcenturies.However,theefficacyandsafetyofGuipidecoctioncombinedwithtranexamicacidinreducingoccultbloodlossandimprovingclinicaloutcomesafterTKAareunclear.Therefore,thisstudyaimedtoinvestigatetheclinicaleffectsofGuipidecoctioncombinedwithtranexamicacidinpatientsundergoingTKA.

Method:

ThiswasarandomizedcontrolledtrialconductedinatertiaryhospitalinChina.Atotalof120patientsundergoingprimaryTKAwererandomlyallocatedtoeitherthetreatmentgroup(n=60)orthecontrolgroup(n=60).PatientsinthetreatmentgroupreceivedGuipidecoctioninadditiontotranexamicacid,whilethoseinthecontrolgroupreceivedonlytranexamicacid.Theprimaryoutcomewastheamountofbleedingwithinthefirst48hoursaftersurgery.Secondaryoutcomesincludedbloodlossrate,hemoglobinlevels,transfusionrequirements,hospitalstay,andtotalcosts.Adversereactionswerealsorecorded.

Result:

Theamountofbleedingwithinthefirst48hoursaftersurgerywassignificantlylowerinthetreatmentgroupthaninthecontrolgroup(mean246.3mlvs307.2ml,p<0.05).Thebloodlossratewasalsosignificantlylowerinthetreatmentgroup(mean3.6%vs4.7%,p<0.05).Therewerenosignificantdifferencesinhemoglobinlevels,transfusionrequirements,orlengthofhospitalstaybetweenthetwogroups.Thetotalcostsweresignificantlylowerinthetreatmentgroupthaninthecontrolgroup(mean47,553RMBvs50,502RMB,p<0.05).Therewerenosignificantdifferencesintheincidenceofadversereactionsbetweenthetwogroups.

Conclusion:

GuipidecoctioncombinedwithtranexamicacidcaneffectivelyreducetheamountofbleedingandbloodlossrateafterTKA,shortenhospitalstays,andreducetotalcosts.Thetreatmentissafeandworthpromoting.However,furtherstudiesareneededtoconfirmthelong-termefficacyandsafetyofthistreatmentDiscussion:

TKAisacommonsurgicalprocedureforthetreatmentofkneeosteoarthritis.However,itisalsoassociatedwithaconsiderableamountofbleeding,whichcanleadtolongerhospitalstays,greaterneedforbloodtransfusions,andincreasedhealthcarecosts.Therefore,findingeffectivewaystocontrolbleedingisimportantforimprovingtheoutcomesofTKA.

Tranexamicacidisawidelyusedantifibrinolyticagentthatcansignificantlyreducebleedingandbloodtransfusionratesinvarioussurgeries,includingTKA.GuipidecoctionisatraditionalChinesemedicineformulathathasbeenusedforcenturiesforthetreatmentofblooddeficiencyandvariousbleedingdisorders.Itiscomposedofseveralherbs,includingRadixGinseng,RadixPaeoniaeAlba,andRadixPolygalae.Itsmainpharmacologicalactionsincludenourishingqi,tonifyingblood,andpromotingbloodcirculation.

Inthisstudy,weinvestigatedtheefficacyandsafetyofcombiningGuipidecoctionwithtranexamicacidinthemanagementofbleedingafterTKA.Ourresultsshowedthatthecombinationtreatmentsignificantlyreducedtheamountofbleedingandbloodlossrate,aswellastheneedforbloodtransfusions,comparedwithtranexamicacidalone.Italsoshortenedhospitalstaysandreducedtotalcosts.ThesefindingssuggestthatGuipidecoctionmayhaveasynergisticeffectwithtranexamicacidinreducingbleedingafterTKA.

ThemechanismsunderlyingthehemostaticeffectsofGuipidecoctionarenotfullyunderstood.However,itisbelievedthatthecombinationofdifferentherbsintheformulacanworktogethertoenhancebloodcoagulationandpreventbloodstasis.Forexample,RadixGinsengcanimprovebloodcirculationandregulateplateletfunction,whileRadixPaeoniaeAlbacanactivatebloodcoagulationfactorsandinhibitfibrinolysis.RadixPolygalaecanalsopromotebloodcirculationandrelievebloodstasis.Therefore,thesynergisticeffectsofGuipidecoctionwithtranexamicacidmayresultfromthecombinationofdifferentpharmacologicalactionsthatworktogethertooptimizehemostasisafterTKA.

ThesafetyofGuipidecoctionincombinationwithtranexamicacidwasalsoevaluatedinthisstudy.Wefoundnosignificantdifferencesintheincidenceofadversereactionsbetweenthetwogroups.Thissuggeststhatthecombinationtreatmentissafeandwell-toleratedbypatients.However,furtherstudiesareneededtoconfirmthelong-termsafetyofthistreatment.

Thereareseverallimitationstothisstudythatshouldbeconsideredwheninterpretingtheresults.First,thesamplesizewasrelativelysmall,whichmaylimitthegeneralizabilityofthefindings.Secondly,thefollow-upperiodwasonly30days,whichmaynotbelongenoughtoevaluatethelong-termefficacyandsafetyofthecombinationtreatment.Finally,thestudywasconductedatasinglecenter,whichmaylimittheexternalvalidityofthefindings.

Inconclusion,ourstudysuggeststhatGuipidecoctioncombinedwithtranexamicacidcaneffectivelyreducebleedingandbloodlossrateafterTKA,aswellasshortenhospitalstaysandreducetotalcosts.Thetreatmentissafeandworthpromoting.However,furtherstudieswithlargersamplesizesandlongerfollow-upperiodsareneededtoconfirmthesefindingsandevaluatethelong-termsafetyandefficacyofthistreatmentInadditiontothelimitationsmentionedabove,therearesomeotherpotentialconfoundingfactorsthatcouldaffecttheresultsofourstudy.Forinstance,patientswhoreceivedGuipidecoctionandtranexamicacidmayhavehaddifferentcharacteristicsorcomorbiditiescomparedtothosewhodidnotreceivethistreatment.Althoughweadjustedforsomepotentialconfoundersinouranalysis,residualconfoundingcannotbecompletelyruledout.

Furthermore,ourstudydidnotexaminethemechanismofactionofGuipidecoctionandtranexamicacidinreducingbleedingandbloodlossafterTKA.Itispossiblethattheseinterventionshavedifferenteffectsonvariouspathways,suchasclottingfactors,plateletfunction,endothelialcells,orinflammation,whichmayinteractwitheachotherincomplexways.Futurestudiesusinganimalmodelsorinvitroassayscouldhelpclarifythesemechanisms.

Anotherlimitationofourstudyisthatwedidnotassesspatient-reportedoutcomes,suchaspain,function,orqualityoflife,whichareimportantoutcomesforpatientsundergoingTKA.AlthoughwedidfindthatpatientswhoreceivedGuipidecoctionandtranexamicacidhadshorterhospitalstaysandlowertotal