本文選題：關(guān)節(jié)成形術(shù) + 置換��； 參考：《中國組織工程研究》2015年35期

【摘要】：背景:目前關(guān)于全膝關(guān)節(jié)置換過程中使用氨甲環(huán)酸減少出血的報(bào)道越來越多,但對(duì)于使用方式的選擇仍存在爭(zhēng)議。目的:通過術(shù)中關(guān)節(jié)腔周圍組織局部注射和靜脈注射兩種不同的給藥途徑,探討氨甲環(huán)酸對(duì)初次單側(cè)全膝關(guān)節(jié)置換后失血量的影響。方法:根據(jù)隨機(jī)對(duì)照原則設(shè)計(jì),選取滕州市中心人民醫(yī)院2013年10月至2014年12月收治擬行單側(cè)全膝關(guān)節(jié)置換的患者90例,隨機(jī)分為靜脈組和局部組(n=45)。靜脈組患者在全身麻醉誘導(dǎo)期接受靜脈輸注氨甲環(huán)酸(10 mg/kg最大劑量1.2 g);局部組于假體安裝結(jié)束后,縫合關(guān)節(jié)囊前,在關(guān)節(jié)周圍軟組織注射氨甲環(huán)酸(2 g溶于50 m L生理鹽水)。比較兩組患者置換后引流量、置換后次日血紅蛋白及紅細(xì)胞壓積、輸血例數(shù),同時(shí)觀察是否有肺栓塞及下肢深靜脈栓塞的臨床癥狀出現(xiàn),必要時(shí)行下肢血管多普勒超聲檢查。結(jié)果與結(jié)論:置換后引流量、置換后次日血紅蛋白值及紅細(xì)胞壓積、輸血人數(shù)及輸血比率比較,兩組差異無顯著性意義(P0.05)。兩組患者置換后14 d均未發(fā)現(xiàn)下肢深靜脈血栓形成。提示與靜脈全身應(yīng)用相比,全膝關(guān)節(jié)置換過程中關(guān)節(jié)周圍局部應(yīng)用氨甲環(huán)酸同樣能達(dá)到有效減少置換后失血和輸血的效果,并可避免靜脈應(yīng)用氨甲環(huán)酸可能帶來的相關(guān)并發(fā)癥。
[Abstract]:Background: there are more and more reports on the use of carbamate to reduce bleeding during total knee arthroplasty, but the choice of use mode is still controversial. Objective: to investigate the effect of carbamoic acid on blood loss after primary total knee arthroplasty by intraoperative injection of intraarticular periarticular tissue and intravenous injection. Methods: according to the principle of randomized control, 90 patients with unilateral total knee arthroplasty were selected from Tengzhou Central people's Hospital from October 2013 to December 2014. They were randomly divided into intravenous group and local group (n = 45). Patients in the intravenous group received intravenous infusion of methocylic acid (10 mg/kg, maximum dose 1.2 g);) during the period of general anesthesia induction. After the prosthesis was installed, the patients in the venous group were injected with the periarticular soft tissue before the closure of the joint capsule (2 g dissolved in 50 mL normal saline). The drainage flow, hemoglobin, hematocrit and blood transfusion were compared between the two groups after replacement. The clinical symptoms of pulmonary embolism and deep vein embolism of lower extremity were observed at the same time. Doppler ultrasound of lower extremities was performed when necessary. Results and conclusion: there was no significant difference in drainage volume, hemoglobin value, hematocrit, number of blood transfusion and blood transfusion ratio between the two groups (P0.05). Deep venous thrombosis of lower extremity was not found in both groups on the 14th day after replacement. The results suggest that local application of carbamoic acid during total knee arthroplasty can also reduce blood loss and blood transfusion effectively and avoid complications caused by intravenous application of carbamoic acid in total knee arthroplasty.
【作者單位】： 滕州市中心人民醫(yī)院關(guān)節(jié)運(yùn)動(dòng)醫(yī)學(xué)二科;解放軍濟(jì)南軍區(qū)總醫(yī)院脊髓修復(fù)科;
【分類號(hào)】：R687.4

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本文編號(hào)：2099495