本文選題：全膝關節(jié)置換術　切入點：氨甲環(huán)酸　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究目的膝關節(jié)腔內局部應用氨甲環(huán)酸(TXA)降低全膝關節(jié)置換術(TKA)后失血量已經(jīng)在臨床上獲得了認可,但是關于TKA后膝關節(jié)腔內注射TXA聯(lián)合引流管夾閉時間的系統(tǒng)研究很少。該實驗研究全膝關節(jié)置換術后氨甲環(huán)酸膝關節(jié)腔內注射不同的引流管夾閉時間對術后失血量、輸血量及并發(fā)癥等的影響,以選擇TKA后TXA膝關節(jié)腔內注射引流管夾閉的最佳時間。研究方法選取2015年1月至2016年3月因膝骨關節(jié)炎入住青島大學附屬醫(yī)院關節(jié)外科并首次行單側TKA的患者152例,入院后對152例患者進行術前檢查及綜合評估,均具有可比性。全部患者于縫合結束后經(jīng)注射器向膝關節(jié)腔內注射TXA注射液(50ml,40 mg/ml)并夾閉引流管,然后繃帶加壓包扎膝關節(jié)并釋放止血帶。根據(jù)釋放止血帶后引流管夾閉的持續(xù)時間將152例患者隨機分為4組(夾閉1 h組、夾閉2 h組、夾閉3 h組、夾閉4 h組),各組38例。計算術中出血量、總失血量、術后可見失血量及隱性失血量,統(tǒng)計術后輸血、患肢皮下瘀斑、患肢膝關節(jié)腫脹及患肢肌間靜脈血栓人數(shù),評估術后6月患肢膝關節(jié)HSS評分(美國特種外科醫(yī)院膝關節(jié)評分)。由SPSS21.0統(tǒng)計軟件包進行數(shù)據(jù)處理,檢驗標準為P0.05。研究結果歷時15個月,對符合條件的152例患者進行實驗并得出數(shù)據(jù),對4組數(shù)據(jù)進行統(tǒng)計學分析得出以下結論:1.在總失血量、術后可見失血量、隱性失血量方面,夾閉3 h組、夾閉4 h組明顯低于夾閉1 h組、夾閉2 h組,且夾閉2 h組明顯低于夾閉1 h組,夾閉3 h組與夾閉4 h組之間比較差別無統(tǒng)計學意義;2.夾閉4 h組術后患肢皮下瘀斑、患肢膝關節(jié)腫脹的發(fā)生率顯著增加,夾閉1h組術后的輸血率明顯增加,與其它三組之間比較差別具有統(tǒng)計學意義;3.4組患者的術后患肢肌間靜脈血栓及術后6月膝關節(jié)HSS評分之間比較,差別無統(tǒng)計學意義。研究結論TKA后TXA膝關節(jié)腔內注射聯(lián)合引流管夾閉3h是最佳選擇,既能最大限度的減少術后失血及輸血,又可以降低術后并發(fā)癥的發(fā)生。研究意義對全膝關節(jié)置換術(TKA)后膝關節(jié)腔內注射氨甲環(huán)酸(TXA)聯(lián)合引流管的夾閉時間進行了比較系統(tǒng)性的研究,為今后的進一步臨床研究提供幫助。
[Abstract]:Objective to reduce the blood loss after total knee arthroplasty (TKA) by local application of TXA in knee joint. However, there is little systematic study on the time of intraarticular injection of TXA and drainage tube after TKA. This experiment was conducted to study the effect of different entrapment time on postoperative blood loss after total knee arthroplasty. Effects of transfusion volume and complications, In order to select the best time of TXA knee joint drainage tube clamping after TKA. Methods from January 2015 to March 2016, 152 patients who were admitted to the Department of Arthroplasty in the affiliated Hospital of Qingdao University and underwent unilateral TKA for the first time were selected. The preoperative examination and comprehensive evaluation of 152 patients after admission were comparable. After suture, all patients were injected with TXA injection 50 mg / ml of 40 mg / ml into the knee joint via syringe and the drainage tube was clamped. According to the duration of drainage tube clamping, 152 patients were randomly divided into 4 groups (1 h clipping group, 2 h clipping group, 3 h clipping group). 38 cases of each group were clamped for 4 h. The amount of blood loss during operation, the total amount of blood loss, the amount of blood loss and recessive blood loss, blood transfusion, subcutaneous ecchymosis of the affected limb, swelling of the knee joint of the affected limb and the number of intermuscular venous thrombosis of the affected limb were calculated. The HSS score of the knee joint of the affected limb was evaluated on June. The data were processed by the SPSS21.0 statistical software package. The results of the study lasted for 15 months. 152 eligible patients were tested and the data were obtained. The following conclusions were drawn by statistical analysis of 4 groups of data: 1. In the total blood loss, the visible blood loss after operation, and the hidden blood loss, the 3 h group was clamped up. 4 h group was significantly lower than 1 h group, 2 h group was significantly lower than 1 h group, and 2 h group was significantly lower than 1 h group. There was no significant difference between 3 h group and 4 h group. 2. Subcutaneous ecchymosis of the affected limb in 4 h clipping group was significantly lower than that in the 2 h group, and there was no significant difference between 3 h group and 4 h group. The incidence of knee joint swelling in the affected limbs was significantly increased, and the blood transfusion rate was significantly increased in the group of 1 hour clipping. Compared with the other three groups, the difference was statistically significant between the patients with postoperative intermuscular venous thrombosis and the HSS score of knee joint on June. Conclusion Intra-articular injection of TXA combined with entrapment of drainage tube for 3 hours after TKA is the best choice, which can minimize postoperative blood loss and blood transfusion. The significance of this study was to study the clamping time of intraarticular injection of TXA and drainage tube after total knee arthroplasty. It will be helpful for further clinical research in the future.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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