本文選題：碘伏 + 游離三碘甲狀腺原氨酸��； 參考：《吉林大學》2015年碩士論文

【摘要】：背景：人工關節(jié)置換術的主要作用是緩解關節(jié)病變帶來的疼痛和改善關節(jié)活動度，低于10%的患者在術后會出現(xiàn)與假體相關的并發(fā)癥，其主要原因是假體周圍無菌環(huán)境的破壞。假體周圍感染（prosthetic jointinfection，PJI）是人工關節(jié)置換術后最嚴重的并發(fā)癥之一，患者除了需要面臨長期住院治療，承擔多次手術和抗生素治療帶來的額外經濟負擔，還需要承擔關節(jié)失去功能甚至致殘的風險。據(jù)統(tǒng)計，初次人工膝關節(jié)置換（total knee arthroplasty，TKA）術后PJI發(fā)生率為1.21%，初次人工髖關節(jié)置換（total hip arthroplasty,THA）術后PJI發(fā)生率為1.07-1.40%。隨著科學技術的進步及醫(yī)療衛(wèi)生水平的提高，人工關節(jié)置換術后PJI的發(fā)生率下降至0.7%。雖然整體術后PJI發(fā)生率有所下降，但隨著人工關節(jié)置換患者數(shù)量的增加，PJI實際患者數(shù)量未見明顯下降，甚至有上升的趨勢。對于初次行人工關節(jié)置換術的無感染的患者，術區(qū)無菌狀態(tài)的保持對術后PJI的預防顯得尤為重要。聚維酮碘（Povidone iodine，PVP-I），又稱碘伏，由于其具有廣譜的強力的殺菌作用，對細菌、病毒、真菌及寄生蟲等均有很強的殺滅作用，且具有不易使微生物產生耐藥，對皮膚黏膜幾乎無刺激，不易發(fā)生過敏反應，作用持久，穩(wěn)定性好，易清洗等優(yōu)點，故在臨床上得到廣泛應用�？紤]其對微生物的殺滅作用持久，且對組織無毒、低刺激性等優(yōu)點，本研究將其用于人工關節(jié)置換術術中沖洗。有實驗表明，使用碘伏作為術中沖洗液，不僅可以高效殺滅污染菌，降低切口感染率，還促進局部組織脫水，使創(chuàng)面干燥，改善血液循環(huán)，從而利于切口愈合。有報道顯示，對燒傷患者使用碘伏沖洗，可導致患者體內碘紊亂，表現(xiàn)為甲狀腺功能的紊亂。長期使用碘伏洗手及漱口及長期接觸碘伏的醫(yī)護人員，存在出現(xiàn)甲狀腺功能紊亂及增加甲狀腺疾病發(fā)病率的風險。使用碘伏灌洗治療化膿性關節(jié)炎，對甲狀腺功能有影響，治療超過1周的患者，甲狀腺功能改變更為明顯。但目前未見使用碘伏進行術區(qū)沖洗，對甲狀腺功能的影響的報道。本文就人工關節(jié)置換術術中使用碘伏沖洗，對患者甲狀腺功能產生的影響進行研究。 目的：本研究通過對比行人工關節(jié)置換術患者，術前和術后第一天游離三碘甲狀腺原氨酸(FT3)、游離甲狀腺素(FT4)、促甲狀腺素(TSH)的變化，探討術中使用碘伏沖洗術區(qū)對甲狀腺功能的影響。 方法：將60名初次行人工關節(jié)置換術的患者隨機分為兩組，實驗組和對照組，每組30人。實驗組患者于術中使用碘伏沖洗術區(qū)，對照組患者于術中使用生理鹽水沖洗術區(qū)。分別于入院時和術后第1天，抽取所有患者靜脈血，檢測FT3、FT4、TSH。 結果：實驗組與對照組間甲狀腺功能變化的差異無統(tǒng)計學意義。（p＞0.05）研究中所有患者，術后FT3、FT4、TSH均較術前有所下降，且術前與術后FT3、FT4、TSH的變化有統(tǒng)計學意義（p＜0.05）。 結論：人工關節(jié)置換手術術中使用碘伏沖洗術區(qū)，不足以影響患者甲狀腺功能的變化。臨床可以使用碘伏沖洗術區(qū)，預防術后感染。手術或麻醉等應激均可導致甲狀腺功能變化，當應激消失后，無甲狀腺相關疾病的患者，均可在短期內代償，不足以引起機體代謝異常。
[Abstract]:Background: the main role of artificial joint replacement is to relieve the pain caused by joint lesions and to improve the degree of joint activity. Less than 10% of patients have complications associated with the prosthesis after operation, mainly due to the destruction of the aseptic environment around the prosthesis. Periprosthetic infection (prosthetic jointinfection, PJI) is the postoperative prosthetic replacement. One of the most serious complications, in addition to the need for long-term hospitalization, takes on the additional economic burden of multiple operations and antibiotic treatment, and the risk of joint loss of function and even disability. According to statistics, the incidence of PJI after primary artificial knee replacement (total knee arthroplasty, TKA) is 1.21%, the first artificial hip The incidence of PJI after total hip arthroplasty (THA) was 1.07-1.40%. with the progress of science and technology and the improvement of medical and health level. The incidence of PJI decreased to 0.7%. after arthroplasty, although the incidence of PJI decreased after total operation, but the number of patients with artificial arthroplasty increased, and the number of PJI patients was not. The preservation of the aseptic state of the surgical area is particularly important for the prevention of postoperative PJI. Polyvidone iodine (Povidone iodine, PVP-I), also known as iodophor, has a wide spectrum of bactericidal effect on bacteria, viruses, fungi and parasites. It has a strong killing effect, and it is not easy to produce resistance to microorganism, almost no irritation to the skin and mucous membrane, not easy to take place anaphylaxis, protracted effect, good stability, easy to clean and so on, so it is widely used in clinical. It is used in the operation of artificial joint replacement. It has been shown that the use of iodophor can not only effectively kill the contaminated bacteria, reduce the infection rate of the incision, but also promote the dehydration of the local tissue, make the wound dry, improve the blood circulation and improve the healing of the incision. It is reported that the use of Iodophor for burn patients can cause the disease. Patients with iodine disorders in the body, manifested as thyroid dysfunction. Long-term use of iodophor washing hands and mouthwash and long-term contact with Iodophor has the risk of thyroid dysfunction and increasing the incidence of thyroid diseases. The changes in the function of the glands are more obvious. However, there is no report of the effect of iodophor irrigation on the thyroid function. The effect of iodophor irrigation on the thyroid function in patients with artificial joint replacement is studied in this paper.
Objective: To investigate the effects of iodophor thyroxine (FT3), free thyroxine (FT4) and thyrotropin (TSH) on the thyroid function in patients undergoing intraoperative intraoperative intraoperative arthroplasty. The effect of iodophor irrigation area on thyroid function was discussed.
Methods: 60 patients with artificial joint replacement were randomly divided into two groups, the experimental group and the control group, with 30 people in each group. The patients in the experimental group were treated with Iodophor irrigation area, and the control group was treated with saline irrigation area during the operation. The venous blood was extracted from all patients at admission and first days after the operation, and FT3, FT4, TSH. were detected.
Results: there was no significant difference in the changes of thyroid function between the experimental group and the control group. (P > 0.05) all the patients in the study were decreased in FT3, FT4, TSH after operation, and the changes of FT3, FT4 and TSH before and after operation were statistically significant (P < 0.05).
Conclusion: the use of iodophor irrigation area in artificial joint replacement is not enough to affect the change of thyroid function. The iodophor irrigation area can be used to prevent postoperative infection. Surgery or anesthesia can lead to the change of thyroid function. After the stress disappears, patients with no thyroid related diseases can be replaced in a short time. Compensation is not enough to cause abnormal metabolism of the body.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.42

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