本文選題：氨甲環(huán)酸 + 膝關(guān)節(jié)置換　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：背景目前全膝關(guān)節(jié)置換已成為治療各種膝關(guān)節(jié)終末期病變最有效的手術(shù)方式,膝關(guān)節(jié)圍手術(shù)期失血一直是困擾關(guān)節(jié)外科醫(yī)生常見問題,氨甲環(huán)酸減少術(shù)后出血的作用日益受到重視,但對于選用何種用藥途徑仍存在爭議目的探討氨甲環(huán)酸靜脈給藥及關(guān)節(jié)腔注射兩種不同給藥途徑對降低TKA術(shù)中、術(shù)后失血量的影響。方法選取60例2015年10月至2016年10月擬行單側(cè)全膝關(guān)節(jié)置換的患者,按性別以分層隨機(jī)分組法分成3組:A組(n=20):不應(yīng)用氨甲環(huán)酸;B組(n=20):應(yīng)用手術(shù)切皮前緩慢靜滴15 mg/kg氨甲環(huán)酸,術(shù)后3 h再給予10 mg/kg氨甲環(huán)酸;C組(n=20):封閉關(guān)節(jié)腔后經(jīng)引流管注入稀釋在50 ml生理鹽水1g氨甲環(huán)酸,3組均在術(shù)后夾閉引流管2 h。記錄各組置換后顯性失血量、隱性失血量、輸血比率、輸血量,同時(shí)觀察是否有肺栓塞及下肢深靜脈栓塞的臨床癥狀。結(jié)果術(shù)后3-5天失血量達(dá)峰值,顯性失血量約占總失血量三分之一。B組及C組患者同A組相比,顯性失血量和隱性失血量均明顯減少,差異有顯著性意義(P0.05);B組與C組在顯性失血量方面差異無顯著性意義(P0.05),在隱性失血量方面B組顯著小于C組(P0.05);B組及C組患者輸血人數(shù)及輸血比率明顯小于A組,差異有顯著性意義(P0.05);3組患者術(shù)后2周,行雙下肢深靜脈血管彩超復(fù)查,均未發(fā)現(xiàn)DVT形成。結(jié)論氨甲環(huán)酸能明顯減少初次單側(cè)人工全膝關(guān)節(jié)置換的圍手期失血量、輸血率及人均輸血量,且不增加DVT形成、PE的風(fēng)險(xiǎn),且靜脈給藥效果更好。
[Abstract]:Background Total knee arthroplasty (TKR) has become the most effective method for the treatment of various end-stage diseases of knee joint. Perioperative bleeding of knee joint has been a common problem for joint surgeons.More and more attention has been paid to the effect of methacylic acid on the reduction of postoperative bleeding. But there are still some controversial aims to explore the two different ways of intravenously administration and intraarticular injection of carbamate in the reduction of TKA.The effect of blood loss after operation.Methods 60 patients with unilateral total knee arthroplasty from October 2015 to October 2016 were randomly divided into three groups according to their sex: group A: group B was treated with carbampicycline group B and group B was given intravenously intravenously for 15 mg/kg before skin incision.Three hours after operation, group C was given 10 mg/kg of methoxycycline for 10 mg/kg. After articular cavity closure, drainage tube was injected and diluted into 50 ml normal saline (1 g). The drainage tube was clamped for 2 h.The apparent blood loss, recessive blood loss, blood transfusion ratio and blood transfusion volume were recorded after replacement. The clinical symptoms of pulmonary embolism and deep vein embolism of lower extremity were observed at the same time.Results the amount of blood loss reached the peak at 3-5 days after operation. The amount of dominant blood loss in group B and group C was significantly lower than that in group A (1/3. B) and group C (P < 0.05), and the amount of dominant blood loss and recessive blood loss in group C were significantly lower than those in group A (P < 0.05).There was no significant difference in the apparent blood loss between group B and group C, but the number and ratio of blood transfusion in group B was significantly lower than that in group C (P 0.05).There was a significant difference in P0.05 group 2 weeks after operation, two weeks after the examination of the deep veins of the lower extremities, no DVT was found.Conclusion the blood loss, blood transfusion rate and blood transfusion volume per person in the first unilateral total knee arthroplasty can be significantly reduced, and the risk of the formation of PE in DVT is not increased, and the effect of intravenous administration is better.
【學(xué)位授予單位】：青島大學(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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