發(fā)布時間：2018-04-05 16:30

  本文選題：氨甲環(huán)酸　切入點：TKA　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過對初次單側(cè)全膝關(guān)節(jié)表面置換術(shù)(TKA)圍手術(shù)期應(yīng)用氨甲環(huán)酸(TXA)的研究,明確靜脈聯(lián)合局部運用氨甲環(huán)酸在能夠有效減少圍手術(shù)期失血量,同時不增加深靜脈血栓(DVT)和肺栓塞(PE)及嚴(yán)重出血事件的發(fā)生率。方法:通過前瞻性研究選擇符合條件的初次單側(cè)TKA病人60例,實驗組30例,對照組30例。實驗組靜脈聯(lián)合局部運用氨甲環(huán)酸,對照組用生理鹽水局部對照,兩組術(shù)后均按指南進(jìn)行規(guī)范的抗凝治療,比較兩組患者在失血量、引流量及深靜脈血栓(DVT)、肺栓塞(PE)及嚴(yán)重出血事件的發(fā)生率。結(jié)果:在失血量的比較方面,兩組在術(shù)中失血量差異無統(tǒng)計學(xué)意義(P=0.164),在術(shù)后引流量及總失血量方面均少于對照組(P =0.000,P=0.000),差異均有統(tǒng)計學(xué)意義。兩組患者在術(shù)后輸血率差異有統(tǒng)計學(xué)意義(P=0.005)。在術(shù)后Hb下降幅度方面,術(shù)后第1天實驗組Hb下降幅度較對照組術(shù)后第1天小,差異有統(tǒng)計學(xué)意義(P=0.028);但是在術(shù)后第3天、第5天實驗組和對照組Hb下降幅度的差異無統(tǒng)計學(xué)意義(P=0.846, P=0.097)。兩組患者在術(shù)后2周、術(shù)后1月均未發(fā)現(xiàn)肺栓塞、下肢深靜脈血栓;但實驗組在術(shù)后3月復(fù)查雙下肢靜脈彩超時發(fā)現(xiàn)2例出現(xiàn)肌間靜脈血栓,對照組在術(shù)后3月發(fā)現(xiàn)1例出現(xiàn)肌間靜脈血栓;兩組患者術(shù)后均未發(fā)現(xiàn)嚴(yán)重出血事件。結(jié)論:在初次單側(cè)全膝關(guān)節(jié)置換術(shù)圍手術(shù)期中靜脈聯(lián)合局部應(yīng)用氨甲環(huán)酸,既能有效控制術(shù)后失血量、減少輸血率,同時也不增加術(shù)后血栓的發(fā)生風(fēng)險。
[Abstract]:Objective: to study the effect of intravenously combined local use of tranexamic acid (TXA) on the perioperative blood loss in patients with primary unilateral total knee arthroplasty (TKAA).At the same time, the incidence of DVT and PE) and severe bleeding events were not increased.Methods: 60 patients with primary unilateral TKA, 30 patients in experimental group and 30 patients in control group were selected by prospective study.The experimental group was given intravenously combined with local administration of carbamate, while the control group was locally controlled by normal saline. The two groups were treated with standard anticoagulant therapy according to the guidelines after operation, and the blood loss was compared between the two groups.Incidence of drainage, DVT, PE and severe bleeding events.Results: there was no significant difference in the amount of blood loss between the two groups (P < 0. 164), but there was no significant difference between the two groups in terms of postoperative drainage volume and total blood loss, which were significantly lower than those in the control group (P < 0. 000).The difference of blood transfusion rate between the two groups was statistically significant.The decrease of HB in the experimental group on the first day after operation was smaller than that in the control group on the first day after operation, and the difference was statistically significant (P < 0.05), but on the third day after operation, the decrease of HB in the experimental group was significantly lower than that in the control group.On the 5th day, there was no significant difference in the decrease of HB between the experimental group and the control group (P 0. 846, P 0. 097).Pulmonary embolism and deep vein thrombosis of lower extremity were not found in both groups 2 weeks after operation and 1 month after operation, but 2 cases of intramuscular venous thrombosis were found in the experimental group 3 months after operation.In the control group, one patient was found to have intramuscular venous thrombosis at 3 months after operation, and no severe bleeding events were found in both groups.Conclusion: combined with local application of carbamoic acid in the perioperative period of primary unilateral total knee arthroplasty can not only effectively control postoperative blood loss and reduce blood transfusion rate, but also do not increase the risk of postoperative thrombosis.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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