發(fā)布時(shí)間：2018-03-08 17:30

  本文選題：膝關(guān)節(jié)表面置換　切入點(diǎn)：氨甲環(huán)酸　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探索分析膝關(guān)節(jié)表面置換術(shù)后關(guān)節(jié)腔灌注氨甲環(huán)酸聯(lián)合術(shù)后間斷引流對(duì)術(shù)后失血的效果,探索一種有效減少膝關(guān)節(jié)表面置換術(shù)后失血的有效方法。方法:篩選自2015年12月至2016年10月在泰山醫(yī)學(xué)院附屬萊蕪醫(yī)院骨科行膝關(guān)節(jié)表面置換的60歲以上患者作為研究對(duì)象,其中男41例,女49例,年齡61~84歲,平均70.4歲,骨性關(guān)節(jié)炎患者75例,類風(fēng)濕患者15例,排除相關(guān)內(nèi)科疾病,改組患者手術(shù)由同一組醫(yī)師在止血帶下完成,均進(jìn)行膝關(guān)節(jié)表面置換,假體統(tǒng)一使用臺(tái)灣聯(lián)合公司提供后穩(wěn)定型關(guān)節(jié),關(guān)閉切口前引流管常規(guī)剪側(cè)孔放置于關(guān)節(jié)腔內(nèi),縫合傷口后均進(jìn)行加壓包扎,術(shù)后根據(jù)引流管注入藥物和術(shù)后引流方式將本組患者隨機(jī)分為三組,A組經(jīng)引流管灌注0.9%的生理鹽水30ml后夾閉引流管,夾閉2小時(shí)放開10分鐘再次夾閉引流管,反復(fù)夾管5次行間斷引流;B組將0.5g氨甲環(huán)酸注射液溶于20ml0.9%的生理鹽水中,經(jīng)引流管灌注于關(guān)節(jié)內(nèi),夾管2小時(shí)后放開行延遲開放引流;C組將0.5g氨甲環(huán)酸注射液溶于20ml0.9%的生理鹽水中,經(jīng)引流管灌注于關(guān)節(jié)內(nèi),術(shù)后行間斷引流。分別記錄(1)三組患者術(shù)后引流袋引流量。(2)所有患者術(shù)前及術(shù)后48小時(shí)常規(guī)行血常規(guī)檢查,并記錄血紅蛋白值(3)分別記錄所有患者術(shù)前及術(shù)后48小時(shí)拔除引流管時(shí)測(cè)量髕上10cm處髕上周徑(4)術(shù)后輸血患者常規(guī)記錄,計(jì)算輸血率(5)術(shù)后2周刀口愈合率,根據(jù)術(shù)后刀口愈合情況如實(shí)記錄(6)記錄術(shù)后2周膝關(guān)節(jié)活動(dòng)情況。使用SPSS 16.0軟件分析所測(cè)數(shù)據(jù),以確定P值,確定差距是否具有臨床意義。結(jié)果:本組90例患者獲得完整隨訪資料,手術(shù)時(shí)間(55-140min),住院天數(shù)(14-20天),90患者中7例刀口淺表感染,通過換藥刀口愈合,刀口愈合率均為100%,C組和B組有3例患者輸血,A組14例患者。在髕上周徑變化值、關(guān)節(jié)活動(dòng)度無統(tǒng)計(jì)學(xué)意義,術(shù)后引流袋引流量和HB變化值C組最優(yōu),其次B組,A組最差。結(jié)論:膝關(guān)節(jié)表面置換術(shù)后灌注氨甲環(huán)酸生理鹽水聯(lián)合間斷引流能有效減少TKA患者術(shù)后失血。
[Abstract]:Objective: to explore the effect of intraarticular instillation of carbamoic acid combined with postoperative intermittent drainage on postoperative blood loss after surface replacement of knee joint. Objective: to explore an effective method to reduce blood loss after knee joint surface replacement. Methods: from December 2015 to October 2016, patients over 60 years old who underwent knee joint surface replacement in Department of Orthopaedics, Laiwu Hospital affiliated to Taishan Medical College were selected as study subjects. Among them, 41 males and 49 females, aged 61 to 84 years (mean 70.4 years), 75 patients with osteoarthritis and 15 patients with rheumatoid diseases were excluded from related internal diseases, and the operation was performed by the same group of doctors under tourniquet. All of them underwent knee joint surface replacement, the prosthesis was unified with the post-stable joint provided by the Taiwan Union Company, and the normal shearing hole of the anterior drainage tube was placed in the joint cavity after closing the incision. After the wound was sutured, the joint was bound under pressure. The patients were randomly divided into three groups according to the drug injection and drainage method after operation. Group A was infused with 0.9% normal saline (30 ml) through the drainage tube and then clipped the drainage tube. The drainage tube was closed again for 10 minutes after clipping for 2 hours. In group B, 0.5 g carbonic acid injection was dissolved in 20 ml 0.9% of normal saline and perfused into joints through drainage tube. In group C, 0.5 g carbamoic acid injection was dissolved in 20 ml 0.9% of normal saline and perfused into the joint through a drainage tube. Discontinuous drainage was performed after operation. 1) drainage bag drainage volume. 2) routine blood routine examination was performed before and 48 hours after operation in all patients. The hemoglobin values were recorded and the routine records of blood transfusion patients were recorded before operation and 48 hours after operation when the drainage tube was removed. The blood transfusion rate was calculated at 5) and the wound healing rate was calculated 2 weeks after operation. The knee joint movement was recorded 2 weeks after operation according to the healing of the knife edge. The data were analyzed by SPSS 16.0 software to determine the P value. Results: 90 patients received complete follow-up data, the operation time was 55-140 mins, the hospitalization time was 14 to 20 days, the superficial infection of knife edge was found in 7 cases, and the wound healed by dressing change. There were 3 patients in group A and 14 patients in group A. There was no statistical significance in the change of patellar diameter and motion of joint. The drainage bag drainage volume and HB change value were the best in group C. Conclusion: after the knee joint surface replacement, the combined infusion of carbamate and normal saline combined with intermittent drainage can effectively reduce postoperative blood loss in patients with TKA.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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