本文關(guān)鍵詞： 人工全膝關(guān)節(jié)置換術(shù) 氨甲環(huán)酸 術(shù)后引流 失血量　出處：《中國修復(fù)重建外科雜志》2017年04期 　論文類型：期刊論文

【摘要】：目的探討靜脈滴注聯(lián)合關(guān)節(jié)腔內(nèi)注射氨甲環(huán)酸后引流管夾閉時間對人工全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)術(shù)后失血量的影響并評價其安全性。方法于2015年9月—2016年7月擬行單側(cè)初次TKA的102例患者中,選取80例符合選擇標(biāo)準(zhǔn)的女性患者納入研究。所有患者隨機(jī)分為對照組(A組)、30 min組(B組)、60 min組(C組)和90 min組(D組),每組20例。4組患者年齡、體質(zhì)量指數(shù)、患膝側(cè)別、病因、病程以及術(shù)前血紅蛋白、白蛋白、紅細(xì)胞壓積等一般資料比較,差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。所有患者均于松止血帶前10 min靜脈滴注氨甲環(huán)酸氯化鈉100 m L(含1 g氨甲環(huán)酸)。關(guān)閉切口后,B、C、D組通過引流管向關(guān)節(jié)腔內(nèi)注射相同濃度氨甲環(huán)酸氯化鈉60 m L并夾閉引流管,A組同法注射60 m L生理鹽水;A、B組于引流管夾閉后30 min、C組于60 min、D組于90 min后恢復(fù)引流。記錄各組患者術(shù)后24 h引流量、總失血量,術(shù)后血紅蛋白、白蛋白減少量,術(shù)后輸血次數(shù)及輸血量,以及下肢深靜脈血栓形成、肺栓塞發(fā)生情況。結(jié)果 B、C、D組術(shù)后24 h引流量及總失血量均少于A組,其中C、D組與A組比較差異有統(tǒng)計學(xué)意義(P0.05),B組與A組比較差異無統(tǒng)計學(xué)意義(P0.05)。B組術(shù)后24 h引流量高于C、D組,且與D組比較差異有統(tǒng)計學(xué)意義(P0.05);C、D組間比較差異無統(tǒng)計學(xué)意義(P0.05)。B、C、D組總失血量組間比較差異無統(tǒng)計學(xué)意義(P0.05)。A~D組血紅蛋白、白蛋白減少量呈逐漸降低趨勢,但各組間差異無統(tǒng)計學(xué)意義(P0.05)。所有患者術(shù)后均無下肢深靜脈血栓形成及肺栓塞發(fā)生。D組1例患者術(shù)后第3天白蛋白28 g/L,靜脈輸入人血白蛋白20 g;其余患者均未輸血。結(jié)論靜脈滴注聯(lián)合關(guān)節(jié)腔內(nèi)注射氨甲環(huán)酸可減少TKA圍手術(shù)期失血量;關(guān)節(jié)腔內(nèi)注射氨甲環(huán)酸后引流管夾閉60 min后再恢復(fù)引流止血效果最佳,并且不增加癥狀性下肢深靜脈血栓形成和肺栓塞發(fā)生率。
[Abstract]:Objective to investigate the effect of intraarticular instillation of total knee arthroplasty on total total knee arthroplasty (TKA) after entrapment of drainage tube after intraarticular injection of aminocyclylic acid. Methods 102 patients with primary unilateral TKA were selected from September 2015 to July 2016. 80 female patients who met the selection criteria were selected. All the patients were randomly divided into control group (group A) and 30 min group (group B). Age, body mass index (BMI), knee side, etiology, course of disease, preoperative hemoglobin and albumin were 20 patients in each group (n = 20, n = 20) and 90 min group (n = 20, n = 20). There was no significant difference in hematocrit and other general data (P0.05). All patients were treated with 100 mL sodium methachloroate (100 mL) (containing 1 g methoxycycline) 10 min before the tourniquet. After closing the incision, all the patients were treated with BMC. In group D, 60 mL saline was injected into the articular cavity by drainage tube and 60 mL saline was injected into the same way by clipping the drainage tube. The drainage was recovered in group A (30 minutes after tube clipping) and in group D (60 minutes) after 90 min. The drainage was recorded 24 hours after operation and the total amount of blood loss was recorded. Hemoglobin, albumin, blood transfusion times, blood transfusion volume, deep vein thrombosis and pulmonary embolism occurred after operation. 24 hours after operation, the drainage volume and total blood loss in group D were lower than those in group A, and the difference between group C and group A was statistically significant (P 0.05). There was no significant difference between group B and group A (P 0.05). 24 hours after operation, the drainage volume in group B was higher than that in group C (D), and there was a significant difference between group B and group D (P 0.05). There was no significant difference in the total blood loss between the two groups. There was no significant difference in total blood loss between the two groups. The amount of albumin decreased gradually. However, there was no significant difference between the three groups (P 0.05). There was no postoperative deep venous thrombosis and pulmonary embolism in group D. one patient in group D had 28 g / L albumin on the 3rd day after operation. Human serum albumin (HSA) was injected intravenously at 20 g; Conclusion intravenous drip combined with intraarticular injection of carbamoic acid can reduce the perioperative blood loss of TKA. The best hemostatic effect was achieved after the drainage tube was clamped for 60 min and the incidence of symptomatic deep vein thrombosis and pulmonary embolism was not increased.
【作者單位】： 四川大學(xué)華西醫(yī)院骨科;
【分類號】：R687.4
【正文快照】： 人工全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)是治療終末期膝關(guān)節(jié)疾病的有效方案,然而術(shù)中、術(shù)后出血是影響患者術(shù)后康復(fù)的主要問題之一。為了減少術(shù)中出血,保證術(shù)野清晰,臨床多使用止血帶。雖然止血帶的應(yīng)用減少了術(shù)中出血量,但限制了術(shù)中創(chuàng)面的有效徹底止血,導(dǎo)致止血帶

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