Total diz protezi cerrahisinde intraartiküler uygulanan traneksamik asit ve adrenalin in postoperatif kanama üzerine etkinliklerinin karşılaştırılması
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Dosyalar
Tarih
2015
Yazarlar
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Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Total diz protezi uygulaması sonrası kanama miktarını azaltmak için ameliyat sonunda diz eklemi içerisine uygulanan traneksamik asit ve adrenalinin kanama üzerine etkileri değerlendirildi. Gereç ve Yöntem: Temmuz 2012 - Aralık 2014 tarihleri arasında primer TDP uygulanan hastalar arasında kriterlere uyan 90 hasta retrospektif olarak incelendi. Kanama bozukluğu olan, antitrombotik veya antiagregan ilaç kullanan, daha önce diz çevresinden cerrahi geçirmiş, TEA ve adrenalin alerjisi olan, patellar komponenti değişmiş olan veya romatolojik nedenlerle TDP yapılmış hastalar çalışma dışı bırakıldı. Hastalar diz içerisine TEA uygulanan, adrenalin uygulanan ve kontrol grubu olmak üzere 3 gruba ayrıldı.Her 3 grupta ameliyat sonunda eklem içerisine dren yerleştilip kapsül kapatıldı. TEA ve adrenalin grubunda ajanlar eklem içine uygulandı. Dren 30 dakika sonra açıldı ve 24 saat sonunda çekildi. Gruplar drenden gelen kan miktarı, preoperatif ve postoperatif 24. saat Hb –Htc farkı açısından karşılaştırıldı. Bulgular: Her 3 grupta yaş, cinsiyet, VKI, ek hastalık, preoperatif Hb-Htc değerleri açısıdan homojen dağılım mevcuttu. Ameliyat öncesi ve ameliyat sonrası 24. saatteki Hb değerleri farkı TEA grubunda 1,68 , adrenalin grubunda 2,30 , kontrol grubunda 2,67 idi. Htc farkı ise TEA grubunda 5,68 , adrenalin grubunda 7,44 , kontrol grubunda 8,37 idi. Hb ve Htc düşüşü istatiksel olarak incelendiğinde diğer iki gruba göre TEA grubunda daha azdı.(p=0,00) Drenden gelen kan miktarı TEA grubunda 321 ml, adrenalin grubunda 615 ml, kontrol grubunda 800 ml olarak ölçüldü. Buna göre drenden gelen kan miktarı açısından TEA ve adrenalin grubu kontrol grubuna göre, TEA grubuda adrenalin grubuna göre anlamlı olarak az kanamıştır. (p=0.00) Hiçbir hastada klinik olarak DVT ve pulmoner emboli tespit edilmedi. Sonuç: TEA nın TDP cerrahisi sonrası lokal olarak eklem içine uygulanması ve ardından drenin belirli süre kapalı bırakılmasının kontrol grubuna göre oldukça etkili olduğu, hatta vazokonstrüktör bir ajan olan adrenalinden daha iyi kanama kontrolü sağladığı tespit edilmiştir. Bu verilere göre eklem içi TEA uygulamasının TDP cerrahisindeki kanama kontrolünde faydalı olacağı kanaatindeyiz
Aim: To evaluate the effects of the application of transexamic acid (TEA) and adrenalin into the knee joint at the end of the operation with the aim of reducing postoperative bleeding after total knee arthroplasty. Material and Method: A retrospective evaluation was made of 90 patients who had undergone total knee arthroplasty (TKA) between July 2012 and December 2014 and met the study criteria. Exclusion criteria included those with a blood disorder, those using antithrombotic or anti-aggregant medication, those who had previously undergone knee surgery, with an allergy to TEA or adrenalin, with a patellar replacement, or with TKA applied for rheumatological reasons. The patients were separated into 3 groups as those administered with TEA, adrenalin and a control group. In the TEA and adrenalin groups, the agents were administered into the joint. The drain was opened 30 minutes later and removed after 24 hours. The groups were compared in respect of the amount of blood in the drain and the difference in Hb-Htc values from preoperative to 24 hours postoperative. Results: All 3 groups were homogenous in respect of age, gender, BMI, comorbidities and preoperative Hb-Htc values. The difference in the Hb value from preoperative to 24 hours postoperatively was determined as 1.68 in the TEA group, 2.30 in the adrenalin group and 2.67 in the control group. The difference in the Htc value from preoperative to 24 hours postoperatively was determined as 5.68 in the TEA group, 7.44 in the adrenalin group and 8.37 in the control group. The decrease in the Hb and Htc values in the TEA group were statistically significantly less than in the other two groups (p=0.00). The amount of blood in the drain was measured as 321 ml in the TEA group, 615 ml in the adrenalin group and 800 ml in the control group. The amount of blood was statistically significantly less in the TEA group and the adrenalin group than in the control group and the TEA group was statistically significantly less than the adrenalin group (p=0.00). No DVT or pulmonary emboli were determined in any patient. Conclusions: Intra-articular application of TEA after TKA and leaving the drain closed for a certain period was extremely effective compared to the control group and was determined to provide better control of bleeding even than adrenalin, which is a vasoconstrictor agent. According to the results of this study, intra-articular application of TEA can be considered useful in the control of postoperative bleeding in TKA surgery.
Aim: To evaluate the effects of the application of transexamic acid (TEA) and adrenalin into the knee joint at the end of the operation with the aim of reducing postoperative bleeding after total knee arthroplasty. Material and Method: A retrospective evaluation was made of 90 patients who had undergone total knee arthroplasty (TKA) between July 2012 and December 2014 and met the study criteria. Exclusion criteria included those with a blood disorder, those using antithrombotic or anti-aggregant medication, those who had previously undergone knee surgery, with an allergy to TEA or adrenalin, with a patellar replacement, or with TKA applied for rheumatological reasons. The patients were separated into 3 groups as those administered with TEA, adrenalin and a control group. In the TEA and adrenalin groups, the agents were administered into the joint. The drain was opened 30 minutes later and removed after 24 hours. The groups were compared in respect of the amount of blood in the drain and the difference in Hb-Htc values from preoperative to 24 hours postoperative. Results: All 3 groups were homogenous in respect of age, gender, BMI, comorbidities and preoperative Hb-Htc values. The difference in the Hb value from preoperative to 24 hours postoperatively was determined as 1.68 in the TEA group, 2.30 in the adrenalin group and 2.67 in the control group. The difference in the Htc value from preoperative to 24 hours postoperatively was determined as 5.68 in the TEA group, 7.44 in the adrenalin group and 8.37 in the control group. The decrease in the Hb and Htc values in the TEA group were statistically significantly less than in the other two groups (p=0.00). The amount of blood in the drain was measured as 321 ml in the TEA group, 615 ml in the adrenalin group and 800 ml in the control group. The amount of blood was statistically significantly less in the TEA group and the adrenalin group than in the control group and the TEA group was statistically significantly less than the adrenalin group (p=0.00). No DVT or pulmonary emboli were determined in any patient. Conclusions: Intra-articular application of TEA after TKA and leaving the drain closed for a certain period was extremely effective compared to the control group and was determined to provide better control of bleeding even than adrenalin, which is a vasoconstrictor agent. According to the results of this study, intra-articular application of TEA can be considered useful in the control of postoperative bleeding in TKA surgery.
Açıklama
Anahtar Kelimeler
Cerrahi tedavi, Surgical treatment, Diz, Knee, Diz eklemi, Knee joint, Diz üstü protezi, Above knee prosthesis, Epinefrin, Epinephrine, Hemorajiler, Hemorrhage, Traneksamik asit, Tranexamic acid
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Durgut, F. (2015). Total diz protezi cerrahisinde intraartiküler uygulanan traneksamik asit ve adrenalin in postoperatif kanama üzerine etkinliklerinin karşılaştırılması. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
