关键词: 全膝关节置换术, 氨甲环酸, 阿司匹林, 低分子肝素钙, 输血率, 血管内皮损伤因子

Abstract: Objective To investigate the value of tranexamic acid combined with aspirin,low molecular weight heparin calcium in regulating inflammatory mediators and TEG in blood management of Total knee arthroplast (TKA).Methods 120 elderly patients with TKA in our hospital from January 2020 to October 2022 were randomly divided into group A (n=60) and group B (n=60).They were given tranexamic acid + aspirin and tranexamic acid + low molecular weight heparin calcium,respectively,for 2 weeks.Perioperative indexes,complications [lower limb deep vein thrombosis (DVT),intermuscular vein thrombosis (MCVT),incision infection],blood transfusion rate,adverse reactions (gastrointestinal discomfort,subcutaneous ecchymosis),TEG parameters[coagulation reaction time (R),blood coagulation time (K),maximum amplitude (MA),coagulation angle (α)],inflammatory mediators[soluble CD40 ligand (sCD40L),Toll-like receptor 4 (TLR4),tumor necrosis factor (TNF-α)],vascular endothelial injury factors[soluble thromboregulatory protein (sTM),vascular endothelial cell growth factor (VEGF),Eselectin] were compared between the two groups.Results  There was no significant difference in the 24 h postoperative drainage volume,latent blood loss,total blood loss,intraoperative blood loss,Hb and HCT levels 72 h after surgery between the two groups (P>0.05).There was no statistically significant difference in TEG parameters between the two groups,at different time points,and between groups at different time points (P>0.05);The serum levels of TLR4,sCD40L and TNF-α in group A were lower than those in group B 2 weeks after surgery (P<0.05).The levels of plasma sTM and serum VEGF and Eselectin in group A were lower than those in group B 2 weeks after surgery (P<0.05).There was no significant difference in the incidence of deep vein thrombosis (DVT),intermuscular vein thrombosis (MCVT),incision infection and blood transfusion rate between group A and group B(P>0.05).There was no significant difference in the total incidence of adverse reactions between group A and group B (P>0.05).Conclusion Compared with the combination of low molecular weight heparin calcium,the combination of tranexamic acid and aspirin can protect vascular endothelium and inhibit inflammatory response.However,both can maintain the patient’s coagulation function and avoid massive blood loss or thrombosis.There is no significant difference in safety and effectiveness.

Key words: knee joint replacement, tranexamic acid, aspirin, low molecular weight heparin calcium, blood transfusion rate, vascular endothelial injury factor