To Explore The Multimodal Blood-loss Prevention Approach On Reducing Blood Loss And Transfusion Rates During Peri-operative Of Unilateral Total Knee Arthroplasty

Objective To discuss and explore the safety and efficacy about the multi-mode blood-loss prevention programs in reducing perioperative blood loss and postoperative transfusion rates on patients who accepted unilateral total knee arthroplasty.Methods.98 patients who met the criteria were randomly divided into two groups which using multi-mode programs to reduce perioperative blood loss as group A(n=49),did not using the program for patients as group B(n=49).All patients before surgey must received blood routine examination,venous ultrasound of lower limbs and so on.The multimodal blood-loss prevention approach which included optimisation about pre-operative haemoglobin(Hb),intravenous use of tranexamic acid,using cocktail analgesic mixture inside the articular,intra-articular injection of tranexamic acid,clamping the drainage tube for three hours after operation,at last when patients returned keeping the knee and hip flexion 30°place and using the other measures.The others patients were as group B(n=49) without using the MBLPA.There were no difference in body mass index,gender composition,age and the other sides between the group A and group B. Recording data such as the values about blood loss about patients,operative time,and specific value of the blood routine examination about all patients on the 1st and 3rd day after surgey.When Hb<80g/L or have obvious symptoms of anemia the patient was given blood transfusion and calculate hidden blood loss,total blood loss and the overt blood loss acording to the formula.Furthermore,the thigh girth(10cm proximal portion from the top of the patella),suprapatellar girth and the calf girth(10cm away from the lower pole of the patella) were measured pre- and post-operatively to investigate whether the MBLPA has an infulence on leg swelling after surgey.Post-operative VAS score was used to evaluate pain condition on 6、24、48、72h.Using Pittsburgh Sleep Quality Index and Knee Society Score to assess the sleep quality and the knee function on patients after surgey.The complications of the patients were observed and recorded when patients had symptoms like deep venous thrombosis we using ultrasound to make sure.We also recording the transfusion rates and the postoperative complications about the two groups.Results The pre-operative condition of the patients was comparable between the two group.The group A with a application of the MBLPA the postoperative values about blood loss,Hct and Hb on the 1、3day were all less than those in the group B(P<0.05).And Group A had a zero transfusion rate, whereas 10 patients(27.77%) and average red blood cell transfusion 111.11 ml in group B received allogenic blood transfusion(P<0.05).Except for the first day after surgey,the sleep quality about group A was better than the patients in group B(P<0.05).Postoperative pain condition in group A on 6h was not different with group B(P>0.05),but on 24、48、72h VAS scores in group A were smaller than group B(P<0.05).Postoperative KSS score of group A were bigger than group B on the 7、14、30day(P<0.05).18 months later,no venous thrombosis and the other complications were happened between the two groups.Conclusions This clinical study showed that the use of MBLPA reduced blood loss significantly with a zero transfusion rate during the unilateral total knee arthroplasty.It also decreased the joint swelling,good for the sleep quality and the KSS score.We else consider the method employed in this study to be effective and safety for the reduction of blood loss,the knee function,the sleep quality,the pain after surgey and knee joint swelling.