Effect of tranexamic acid on ischemia － reperfusion injury caused by application of tourniquet in the surgery of total knee arthroplasty

INTRODUCTION: Tranexamic acid can effectively reduce the amount of perioperative bleeding in artificial joint replacement surgery, but some reports showing that the application of tranexamic acid in cardiac surgery can reduce the ischemia-reperfusion injury. Does tranexamic acid reduce the tourniquet Ischemia-reperfusion injury in the surgery of toutal knee arthroplasty is unclear. HYPOTHESES: To observe the effect of intravenous combined local tranexamic acid on the expression of IL-6 and TNF-α in peripheral blood and drainage fluid of patients with tourniquet in primary total knee arthroplasty METHODS: Sixty patients with knee osteoarthritis were selected from 2017-07 to 2018-06 to proceed primary knee arthroplasty in our hospital. The random digital table was used to divide them into tranexamic acid group and normal saline group, with 30 cases in each group. In the tranexamic acid group, tranexamic acid 1g in 100ml normal saline was infused intraoperatively and at 3 h after operation. After incision, the infusion of tranexamic acid 1g in 100ml normal saline was performed. The saline group only 100 ml of physiological saline was infused during the same period of time, and 100 ml of physiological saline was locally perfused. The operation time, intraoperative blood loss, and drainage volume at 24 hours after operation were compared. The levels of IL-6 and TNF-α in the drainage fluid before and after surgery were compared between the two groups. RESULTS: The drainage volume of tranexamic acid group was lower than that of normal saline group (P < 0.05). The levels of IL-6 and TNF-α in serum were lower than those in normal saline group at 24h and 72h after operation. The difference was statistically significant. (P < 0.05); the expression of IL-6 and TNF-α in the drainage fluid was significantly lower than that in the saline group at 24 hours after surgery (P < 0.05) CONCLUSION: Combined use of tranexamic acid can effectively reduce the expression of IL-6 and TNF-α in local drainage fluid and peripheral serum after TKA in patients with TKA, thus reducing the local and systemic inflammatory response.