本文選題：氨甲環(huán)酸 + 關(guān)節(jié)成形術(shù)��； 參考：《第三軍醫(yī)大學》2017年碩士論文

【摘要】：研究背景及目的多年來失血和疼痛一直是是全膝關(guān)節(jié)置換術(shù)(TKA)后的兩個主要問題。但是目前,臨床上應(yīng)用氨甲環(huán)酸來減少全膝關(guān)節(jié)置換術(shù)后出血,被證明是安全和有效的。局部應(yīng)用鎮(zhèn)痛雞尾酒不僅可以減輕術(shù)后膝關(guān)節(jié)疼痛,還可減少術(shù)后失血。關(guān)于兩者局部聯(lián)合應(yīng)用的研究較少。本研究主要探討局部應(yīng)用氨甲環(huán)酸(TXA)復(fù)合鎮(zhèn)痛雞尾酒對減少全膝關(guān)節(jié)置換術(shù)后失血有效性及安全性的影響。方法將2015年8月—2016年6月期間擬在第三軍醫(yī)大學附屬新橋醫(yī)院行TKA的膝骨關(guān)節(jié)炎患者共計60例納入研究,其中男性13例,女性47例;退行性骨關(guān)節(jié)炎16例,創(chuàng)傷性骨關(guān)節(jié)炎44例;年齡51~80歲,平均65.6歲。采用隨機數(shù)字表法隨機分為兩組,A組為單用鎮(zhèn)痛雞尾酒組(30例),于TKA術(shù)中置入假體前在膝關(guān)節(jié)內(nèi)多點注射鎮(zhèn)痛雞尾酒;B組為局部聯(lián)合應(yīng)用氨甲環(huán)酸和鎮(zhèn)痛雞尾酒組(30例),于TKA術(shù)中置入假體前在膝關(guān)節(jié)內(nèi)多點注射氨甲環(huán)酸復(fù)合鎮(zhèn)痛雞尾酒。比較兩組術(shù)中失血量、術(shù)后引流量、隱性失血量、術(shù)后總失血量、血紅蛋白變化值、Hct變化值、特種外科醫(yī)院(HSS)膝關(guān)節(jié)評分、輸血率、深靜脈血栓(DVT)及其他并發(fā)癥發(fā)生率。結(jié)果B組圍手術(shù)期Hb的降低值為18.5(13.0,26.0)g/L,少于A組的23.0(21.0,35.5)g/L(P0.05)。Hct的降低值,B組為5.6(4.1,7.8)%,明顯少于A組的7.2(6.1,10.7)%(P0.05)。B組的術(shù)后引流量為105.0(60.0,223.8)ml,A組為162.5(118.8,245.0)ml,B組明顯較少(P0.05)。在總失血量上,B組為596.0(426.1,795.3)ml,A組為788.3(583.0,1082.4)ml,前者明顯少于后者(P0.05)。B組的隱性失血量為422.3(228.9,624.0)ml,少于A組的603.2(435.2,884.7)ml(P0.05)。在術(shù)中失血量、HSS膝關(guān)節(jié)評分、輸血率、DVT及其他并發(fā)癥發(fā)生率上差異無統(tǒng)計學意義(P0.05)。結(jié)論在全膝關(guān)節(jié)置換術(shù)中局部聯(lián)合應(yīng)用氨甲環(huán)酸和鎮(zhèn)痛雞尾酒可減少圍手術(shù)期失血,并且不增加術(shù)后深靜脈血栓發(fā)生的風險。
[Abstract]:Background and objective Blood loss and pain have been two major problems after total knee arthroplasty (TKA) for many years. At present, the clinical application of carbamoic acid to reduce bleeding after total knee arthroplasty has proved to be safe and effective. Local application of analgesic cocktail can not only reduce postoperative knee pain, but also reduce postoperative blood loss. There are few studies on the local combination of the two. The purpose of this study was to investigate the effect of local application of TXA compound analgesia cocktail on the efficacy and safety of reducing blood loss after total knee arthroplasty. Methods A total of 60 patients with knee osteoarthritis, including 13 males and 47 females and 16 patients with degenerative osteoarthritis, were enrolled in the study from August 2015 to June 2016 at Xinqiao Hospital affiliated to the third military Medical University. There were 44 cases of traumatic osteoarthritis, the age was 51 ~ 80 years (mean 65.6 years). Two groups were randomly divided into two groups: group A: single analgesic cocktail group (n = 30). Before implantation of prosthesis during TKA, analgesia cocktails were injected into the knee joint. Group B was used locally as a combination of triacycline and analgesic cocktails. Group A (n = 30) were treated with multiple injection of carbamocytic acid (MA) combined with analgesia cocktails in knee joint before implantation of prosthesis during TKA. The blood loss, postoperative drainage, recessive blood loss, total blood loss, hemoglobin change value and HSS knee joint score, blood transfusion rate, DVT (DVT) and other complications were compared between the two groups. Results the decreasing value of HB in group B was 18.5- 13.0 / 26.0g / L, which was less than that of group A (23.021.0g / L, 35.5g / L). The decrease of HB in group B was 5.64.1g / L ~ 7.8g / L, which was significantly lower than that in group A (7.26.110.7a) and the postoperative drainage volume of group A was 105.60.0223.8ml / L (162.5 / 118.245.0ml / L) compared with that of group A (P 0.05 / 0.05ml / L, P = 0.05), and that of group B was significantly lower than that of group B (P = 0.05). The postoperative drainage volume of group B was significantly lower than that of group B (P < 0.05), and that of group B was significantly lower than that of group B (P < 0.05). The total amount of blood loss in group B was 596.0 / 426.1795.3ml / ml, 788.3n / 583.0N / 1082.4 / ml, respectively, which was significantly lower than that in group B (422.3228.24.960ml) and 603.2435.2884.7ml / ml (P0.05N), respectively, compared with that in group A (P0.05ml, P 0.05), and that in group B was less than that in group B (P < 0.05), and that in group B was less than that in group B (P < 0.05). There was no significant difference in HSS score, blood transfusion rate, DVT and other complications during operation (P 0.05). Conclusion Local application of carbamoic acid and analgesic cocktail in total knee arthroplasty can reduce perioperative blood loss and does not increase the risk of postoperative deep venous thrombosis.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

【參考文獻】

相關(guān)期刊論文 前7條

1 陳光;李靖年;;準確理解和掌握《中國骨科大手術(shù)靜脈血栓栓塞癥預(yù)防指南》[J];醫(yī)學與哲學(B);2016年08期

2 田偉;;中國骨科大手術(shù)靜脈血栓栓塞癥預(yù)防指南[J];中華骨科雜志;2016年02期

3 馬金輝;孫偉;高福強;王云亭;李子榮;;氨甲環(huán)酸在人工關(guān)節(jié)外科領(lǐng)域的應(yīng)用[J];中國骨與關(guān)節(jié)雜志;2014年11期

4 蔡元真;朱錦宇;朱慶生;;人工全膝關(guān)節(jié)置換術(shù)圍手術(shù)期失血量的影響因素及預(yù)防[J];中華臨床醫(yī)師雜志(電子版);2013年01期

5 ;骨關(guān)節(jié)炎診斷及治療指南[J];中華風濕病學雜志;2010年06期

6 邱貴興;楊慶銘;余楠生;翁習生;王凱;李曉林;;低分子肝素預(yù)防髖、膝關(guān)節(jié)手術(shù)后下肢深靜脈血栓形成的多中心研究[J];中華骨科雜志;2006年12期

7 傅愛鳳,鄭志惠,王愛琴,陳俊娟,歐運嬌;疼痛對創(chuàng)傷骨科術(shù)后患者生命體征的影響[J];護理學雜志;2005年20期

，

本文編號：1855043