本文選題：氨甲環(huán)酸 + 關(guān)節(jié)腔內(nèi)注射�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討術(shù)中關(guān)節(jié)腔內(nèi)注射氨甲環(huán)酸(tranexamic acid,TXA)對(duì)減少全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)患者術(shù)后失血的有效性及安全性。[方法]納入64例2015年10月-2017年1月在昆明醫(yī)科大學(xué)第二附屬醫(yī)院骨科因重度膝關(guān)節(jié)骨性關(guān)節(jié)炎(knee osteoarthritis,KOA)行單側(cè)全膝關(guān)節(jié)置換術(shù)的患者,進(jìn)行隨機(jī)雙盲對(duì)照臨床實(shí)驗(yàn)。按數(shù)字隨機(jī)表法分為兩組:實(shí)驗(yàn)組(n=32),其中男性4例,女性28例,年齡52-81歲,平均66.03±8.77歲,左側(cè)19例,右側(cè)13例。對(duì)照組(n=32),其中男性3例、女性29例,年齡51-80歲,平均63.84±9.47歲,左側(cè)20例,右側(cè)12例。實(shí)驗(yàn)組在縫合關(guān)節(jié)囊后向關(guān)節(jié)腔中打入含1g氨甲環(huán)酸的“雞尾酒療法”50ml,對(duì)照組打入單純“雞尾酒療法”50ml。兩組患者均用大紗布加壓包扎術(shù)膝,引流管皆?shī)A閉,4h后改為負(fù)壓引流。比較兩組患者術(shù)后1天、3天、出院時(shí)血紅蛋白和紅細(xì)胞壓積,術(shù)中失血量、術(shù)后可見(jiàn)失血量、顯性失血量,輸血量、輸血率;術(shù)后1天凝血酶原時(shí)間、活化部分凝血活酶時(shí)間、纖維蛋白原、抗凝血酶、凝血酶時(shí)間、溶栓二聚體定量、視覺(jué)模擬評(píng)分、術(shù)口延遲愈合率、感染率、下肢深靜脈血栓發(fā)生率有無(wú)統(tǒng)計(jì)學(xué)差異。[結(jié)果]實(shí)驗(yàn)組術(shù)后可見(jiàn)失血量、顯性失血量、輸血量、輸血率皆低于對(duì)照組,兩者相比差異有統(tǒng)計(jì)學(xué)意義(p0.05);實(shí)驗(yàn)組術(shù)后第1、3天血紅蛋白和紅細(xì)胞壓積高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05);實(shí)驗(yàn)組和對(duì)照組出院時(shí)血紅蛋白和紅細(xì)胞壓積,術(shù)后一天凝血酶原時(shí)間、活化部分凝血活酶時(shí)間、纖維蛋白原、抗凝血酶、凝血酶時(shí)間、溶栓二聚體定量、視覺(jué)模擬評(píng)分、術(shù)口延遲愈合率、感染率、下肢深靜脈血栓發(fā)生率相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。[結(jié)論]局部應(yīng)用氨甲環(huán)酸能有效減少全膝關(guān)節(jié)置換術(shù)后失血和輸血率,且不增加術(shù)口延遲愈合率、感染率和下肢深靜脈血栓發(fā)生率,是有效且安全的。
[Abstract]:[objective] to investigate the efficacy and safety of intraarticular injection of tranexamic acidosis (TXA) in reducing postoperative blood loss in patients with total knee arthroplasty. [methods] A randomized double-blind controlled clinical trial was conducted in 64 patients undergoing unilateral total knee arthroplasty in Department of Orthopaedics, second affiliated Hospital of Kunming Medical University from October 2015 to January 2017. According to the digital random table method, the experimental group was divided into two groups: experimental group (n = 4), male (n = 4), female (n = 28), aged 52-81 years (mean, 66.03 鹵8.77), left (n = 19) and right (n = 13). In the control group, there were 3 males and 29 females, aged from 51 to 80 years, with an average age of 63.84 鹵9.47, left in 20 and right in 12. In the experimental group, 50 ml "cocktail therapy" containing 1 g carbamoic acid was injected into the articular cavity after the joint capsule was sutured, while the control group was injected with the simple "cocktail therapy" of 50 ml. In both groups, the knee was bound with gauze, and the drainage tube was clamped for 4 h and then replaced by negative pressure drainage. The hemoglobin and hematocrit, blood loss, visible blood loss, dominant blood loss, blood transfusion rate, prothrombin time and activated partial thromboplastin time were compared between the two groups 1 day after operation and 3 days after operation. Fibrinogen, antithrombin, thrombin time, thrombolytic dimer quantitative, visual analogue score, operative mouth delayed healing rate, infection rate, lower extremity deep vein thrombosis incidence were statistically different. [results] the blood loss, dominant blood loss and blood transfusion rate in the experimental group were all lower than those in the control group (P 0.05), the hemoglobin and hematocrit in the experimental group were higher than those in the control group on the 1st day after operation. The hemoglobin and hematocrit, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin time, thrombin time, thrombolytic dimer were measured in the experimental group and control group. There was no significant difference in visual analogue score, delayed healing rate, infection rate, and the incidence of deep venous thrombosis in lower extremities (P 0.05). [conclusion] Local application of carbonic acid can effectively reduce the blood loss and blood transfusion rate after total knee arthroplasty without increasing the rate of delayed healing, infection rate and the incidence of deep vein thrombosis of lower extremity, which is effective and safe.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.4

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