發(fā)布時間：2018-03-06 19:01

  本文選題：膝骨性關(guān)節(jié)炎　切入點：全膝關(guān)節(jié)置換術(shù)　出處：《泰山醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 比較單側(cè)人工全膝關(guān)節(jié)置換術(shù)后放置閉式引流(不夾閉，夾閉4小時、6小時)與不放置閉式引流對隱性失血的差異以及對術(shù)后康復(fù)功能鍛煉的影響，分析討論術(shù)后放置引流后的不同處理方式對隱性失血及康復(fù)鍛煉的影響，從而選擇最佳措施，指導(dǎo)臨床工作。 方法 對我院2011年9月～2013年2月112例行單側(cè)人工全膝關(guān)節(jié)置換術(shù)的患者隨機分為放置閉式引流（不夾閉組，夾閉4h組、6h組）與不放置閉式引流組4組，進行前瞻性研究，所有患者均由同一組醫(yī)師完成手術(shù)，既往無膝關(guān)節(jié)手術(shù)史，均為初次行膝關(guān)節(jié)置換術(shù)，均使用連續(xù)硬膜外麻醉，采用相同術(shù)式操作，術(shù)中術(shù)后血壓平穩(wěn)。根據(jù)身高，體重，手術(shù)前后的紅細胞壓積(Hct)以及輸血量，通過Gross方程推算術(shù)后總失血量，分別比較四組患者術(shù)后48h引流量，計算出隱性失血量，且對患者術(shù)后2天、7天、2周的VAS疼痛評分測定及12月后膝關(guān)節(jié)功能（HSS評分）情況進行評價。使用統(tǒng)計學(xué)軟件SPSS19.0進行統(tǒng)計學(xué)分析，用均數(shù)±標準差(x±s)來表示所有測得的計量資料，采用one-wayANOVA方差分析對多個樣本之間的數(shù)據(jù)進行比較，組間兩兩比較采用t檢驗。計數(shù)資料采用行x列表資料的卡方檢驗，P0.05為無統(tǒng)計學(xué)差異。 結(jié)果 四組間的一般臨床資料在統(tǒng)計學(xué)上差異無顯著性意義。單側(cè)人工全膝關(guān)節(jié)置換術(shù)后使用閉式引流組總失血量明顯多于未使用閉式引流組，且有統(tǒng)計學(xué)意義(P=0.05)；早期夾閉組(4h組和6h組)的總引流量均顯著低于未夾閉組，且有統(tǒng)計學(xué)意義(P0.01)；夾閉6h組隱性失血量較未放置引流組、未夾閉組少，且有統(tǒng)計學(xué)意義（P0.01）；夾閉4h組與夾閉6h組在隱性失血量上無差異(P0.05)；不放置引流組與放置引流組比較，VAS評分在術(shù)后2d、7d及2周明顯增高，差異有統(tǒng)計學(xué)意義(P0.01)；放置引流組中，未夾閉組與夾閉4h、6h組相比在術(shù)后2d和7d的VAS評分明顯減少，差異具有統(tǒng)計學(xué)意義(P0.01)，，夾閉4h與6h組間VAS疼痛評分無明顯差異(P0.05)。至術(shù)后2周，放置引流3組間的VAS評分無統(tǒng)計學(xué)差異(P0.05)。術(shù)后相關(guān)合并癥及術(shù)后12月后HSS評分方面四組間差異無顯著性意義(P0.05)。 結(jié)論 引流管早期夾閉能夠明顯減少全膝關(guān)節(jié)置換術(shù)后的失血量，且不增加相關(guān)的術(shù)后并發(fā)癥，早期功能康復(fù)的整體效果明顯，術(shù)后患者的疼痛較未放置閉式引流者明顯減輕，其中夾閉6h組隱性失血量及總失血量較未夾閉組和夾閉4h組少，是一個比較好的時間選擇。故TKA術(shù)后常規(guī)夾管6h方法簡單，臨床效果良好，具有一定的使用價值。
[Abstract]:Purpose. To compare the difference between closed drainage (no clamping, clamping for 4 hours and 6 hours) and closed drainage after unilateral total knee arthroplasty on recessive blood loss and the effect on rehabilitation function training after operation. To analyze and discuss the influence of different ways of treatment after drainage on recessive blood loss and rehabilitation exercise, so as to select the best measures to guide the clinical work. Method. Patients undergoing unilateral total knee arthroplasty from September 2011 to February 2013 in our hospital were randomly divided into 4 groups: closed drainage group (no clamping group, clamping 4 h group, 6 h group) and no closed drainage group (4 h group). All the patients were operated by the same group of doctors. They had no history of knee joint surgery. All patients underwent knee arthroplasty for the first time. All patients were treated with continuous epidural anesthesia with the same operation. The blood pressure was stable after operation, according to height and weight, The hematocrit before and after operation and the amount of blood transfusions were calculated by Gross equation. The total blood loss was estimated by Gross equation, and the recessive blood loss was calculated by comparing the drainage volume at 48 hours after operation in the four groups. The VAS pain score and the knee function score after December were evaluated. The statistical software SPSS19.0 was used for statistical analysis, and the mean 鹵standard deviation (x 鹵s) was used to represent all the measured data. One-wayANOVA analysis of variance was used to compare the data among multiple samples, and t test was used to compare the data between groups. The counting data were analyzed by chi-square test (P05) with x list data. No statistical difference was found between the two groups. Results. There was no statistically significant difference in the general clinical data among the four groups. The total blood loss in the closed drainage group was significantly higher than that in the non-closed drainage group after unilateral total knee arthroplasty. The total drainage volume in the early clipping group was significantly lower than that in the unclamped group (4 h and 6 h group), and there was significant difference between the two groups (P 0.01), and the recessive blood loss in the 6 h clipping group was less than that in the no drainage group. There was no significant difference in the amount of recessive blood loss between the group of 4 h and the group of 6 h. The score of VAS in the group without drainage was significantly higher than that in the group without drainage at 2 days and 2 weeks after operation, and the difference was statistically significant (P 0.01), and that in the group without drainage was significantly higher than that in the group without drainage (P 0.01), and there was no significant difference in the amount of recessive blood loss between the groups of 4 h and 6 h. The VAS scores in the non-clipping group were significantly lower than those in the 4-hour and 6h group, and the difference was statistically significant (P 0.01). There was no significant difference in the VAS pain score between the 4 h and 6 h clipping groups (P 0.05) from 2 weeks to 2 weeks after operation. There was no significant difference in VAS scores among the three groups (P 0.05). There was no significant difference in the HSS scores between the four groups in postoperative complications and December. Conclusion. The early clamping of drainage tube can significantly reduce the amount of blood loss after total knee arthroplasty, and does not increase the postoperative complications. The overall effect of early functional rehabilitation is obvious. The pain of postoperative patients is significantly reduced than that of patients without closed drainage. The recessive blood loss and total blood loss in the 6 h clipping group were less than those in the unclipped group and the clipping 4 h group, which was a better choice of time. Therefore, the routine 6 h clamp method after TKA operation was simple, the clinical effect was good, and it had certain practical value.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R687.4

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相關(guān)期刊論文 前1條

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