本文關(guān)鍵詞： 關(guān)節(jié)成形術(shù) 置換 膝 失血 手術(shù) 氨甲環(huán)酸 糖尿病 組織工程 骨科植入物 人工假體 全膝關(guān)節(jié)置換 有效性 安全性　出處：《中國組織工程研究》2017年11期 　論文類型：期刊論文

【摘要】：背景:全膝關(guān)節(jié)置換術(shù)創(chuàng)傷大,出血量多,多采用氨甲環(huán)酸減少出血。合并糖尿病的患者抗感染及組織愈合能力較差,加之可能存在的血管病變,氨甲環(huán)酸的應(yīng)用是否會(huì)達(dá)到止血的目的且不增加下肢靜脈血栓形成的風(fēng)險(xiǎn),尚無相關(guān)文獻(xiàn)報(bào)道。目的:探討2型糖尿病患者全膝關(guān)節(jié)置換時(shí)應(yīng)用氨甲環(huán)酸減少出血的安全及有效性。方法:選擇2013年1月至2015年1月在貴州省骨科醫(yī)院就診并接受單側(cè)全膝關(guān)節(jié)置換治療的100例合并2型糖尿病的患者,2014年1月以前手術(shù)的46例患者為對(duì)照組,2014年1月以后手術(shù)的54例患者為試驗(yàn)組。試驗(yàn)組將15 mg/kg的氨甲環(huán)酸稀釋于250 m L氯化鈉溶液中在安置假體后松止血帶前給予靜脈點(diǎn)滴,對(duì)照組在相同時(shí)間給予250 m L氯化鈉溶液靜脈點(diǎn)滴。比較2組患者圍手術(shù)期出血、輸血情況、血紅蛋白、紅細(xì)胞比容以及凝血指標(biāo)水平,并觀察下肢深靜脈血栓發(fā)生情況。結(jié)果與結(jié)論:(1)試驗(yàn)組術(shù)后引流量、總出血量、隱性失血量、術(shù)后輸血量及術(shù)后輸血率均小于對(duì)照組(P0.05);(2)術(shù)前2組患者血紅蛋白質(zhì)量濃度和紅細(xì)胞比容差異無顯著性意義;2組患者術(shù)后3 h,1 d和3 d的血紅蛋白質(zhì)量濃度及紅細(xì)胞比容均較術(shù)前下降,術(shù)后5 d有所回升,但低于術(shù)前。試驗(yàn)組在術(shù)后相應(yīng)時(shí)間點(diǎn)的血紅蛋白質(zhì)量濃度及紅細(xì)胞比容均高于對(duì)照組(P0.05);(3)2組患者術(shù)前、松止血帶時(shí)、術(shù)后3 h、術(shù)后1 d、術(shù)后5 d的凝血酶原時(shí)間、活化部分凝血活酶時(shí)間、纖維蛋白原差異無顯著性意義。術(shù)前、松止血帶時(shí)2組患者的D-二聚體差異無顯著性意義,術(shù)后3 h,1 d及后5 d 2組患者的D-二聚體水平均較術(shù)前升高,且試驗(yàn)組術(shù)后3 h及1 d時(shí)小于對(duì)照組,差異有顯著性意義(P0.05),術(shù)后5 d時(shí)2組D-二聚體水平差異無顯著性意義;(4)術(shù)后5 d及術(shù)后1個(gè)月時(shí)2組患者雙下肢靜脈彩超未見明顯下肢深靜脈血栓形成;(5)結(jié)果提示,2型糖尿病患者全膝關(guān)節(jié)置換術(shù)中在松止血帶前按15 mg/kg靜脈應(yīng)用氨甲環(huán)酸以減少出血是安全、有效的。
[Abstract]:Background: total knee arthroplasty has the advantages of large trauma, large amount of blood loss, and the use of carbamoic acid to reduce bleeding. Patients with diabetes mellitus have poor ability of anti-infection and tissue healing, together with possible vascular diseases. Whether the use of carbamoic acid can achieve the purpose of hemostasis and does not increase the risk of venous thrombosis in the lower extremity. Objective: to investigate the safety and efficacy of the application of carbamoic acid in reducing bleeding in patients with type 2 diabetes mellitus after total knee arthroplasty. From January 2013 to January 2015, 100 patients with type 2 diabetes mellitus were treated with unilateral total knee arthroplasty at Guizhou Orthopaedic Hospital. Before January 2014, 46 patients were treated as control group. After January 2014, 54 patients underwent operation in the trial group. The experimental group diluted 15 mg/kg of carbamoic acid to 250m. L sodium chloride solution was given intravenously before the release of the tourniquet after the prosthesis was placed. The control group was given 250 mL sodium chloride solution intravenously at the same time. The perioperative bleeding, blood transfusion, hemoglobin, erythrocyte volume and coagulation index were compared between the two groups. Results and conclusion the postoperative drainage volume, total blood loss, recessive blood loss, postoperative blood transfusion volume and postoperative blood transfusion rate in the test group were lower than those in the control group (P 0.05). (2) there was no significant difference in hemoglobin concentration and erythrocyte volume between the two groups before operation. The hemoglobin concentration and erythrocyte specific volume of the two groups were decreased at 1 and 3 days after operation, and increased at 5 days after operation. The hemoglobin concentration and erythrocyte specific volume in the test group were higher than those in the control group at the corresponding time after operation (P 0.05). There was no significant difference in prothrombin time, activated partial thromboplastin time and fibrinogen between the two groups. There was no significant difference in D-dimer between the two groups at the time of loosening tourniquet. The level of D-dimer in group 2 was higher than that before operation 3 hours after operation and 5 days after operation. At 3 h and 1 d after operation, there was a significant difference in the levels of D- dimer between the two groups (P 0.05), and there was no significant difference in the level of D- dimer between the two groups at 5 days after operation. 4) on the 5th day after operation and 1 month after operation, there was no obvious deep vein thrombosis in both groups. 5) the results suggest that it is safe and effective for patients with type 2 diabetes to reduce bleeding by intravenous injection of carbonic acid 15 mg/kg before loosening tourniquet during total knee arthroplasty.
【作者單位】： 貴州省骨科醫(yī)院骨外科;
【分類號(hào)】：R587.1;R687.4
【正文快照】： 文章快速閱讀:2型糖尿病患者全膝關(guān)節(jié)置換術(shù)中在松止血帶前應(yīng)用氨甲環(huán)酸安全有效觀察指標(biāo):結(jié)論:試驗(yàn)組54例:比較2型糖尿病患者將15 mg/kg的氨甲環(huán)酸2組患者術(shù)后引流量、總出血量、隱全膝關(guān)節(jié)置換術(shù)稀釋于250 mL氯化鈉溶性失血量、術(shù)后輸血中在松止血帶前液中在安置假體后松止

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