本文選題：膝骨性關(guān)節(jié)炎 + 全膝關(guān)節(jié)置換術(shù)　； 參考：《廣州中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：本研究擬對(duì)全膝關(guān)節(jié)置換(Total Knee Arthroplasty TKA)患者在術(shù)中及術(shù)后使用止血藥(氨甲環(huán)酸(Tranexamic Acid TXA))進(jìn)行評(píng)估,評(píng)價(jià)其對(duì)術(shù)后隱性出血隱性失血(Hidden Blood Loss HB L)的影響及安全性。同時(shí)對(duì)全膝關(guān)節(jié)置換術(shù)患者術(shù)后使用活血化瘀中藥預(yù)防深靜脈栓塞(Deep Vein Thrombosis DVT),評(píng)估其對(duì)術(shù)后隱性失血的影響及安全性,為活血化瘀中藥在人工關(guān)節(jié)圍手術(shù)期中的應(yīng)用提供依據(jù)。方法：采用隨機(jī)對(duì)照研究設(shè)計(jì)方案選擇符合納入標(biāo)準(zhǔn)的膝關(guān)節(jié)骨性關(guān)節(jié)炎患者,并于我院行單側(cè)TKA的病例共90例做為研究的對(duì)象。其中A組：活血化瘀中藥組,30例；B組：活血化瘀中藥聯(lián)合氨甲環(huán)酸治療組,30例；C組：生理鹽水對(duì)照組,30例。三組患者均由同一主刀施行手術(shù),術(shù)后三組患者都進(jìn)行一致的康復(fù)鍛煉計(jì)劃,術(shù)后均約2周出院。分析患者手術(shù)前的病情,將資料進(jìn)行量化,再通過(guò)采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行分析三組病例的術(shù)前病情資料,進(jìn)行樣本同質(zhì)性比較,若分析結(jié)果提示三組病人的術(shù)前病情資料具有可比性,就進(jìn)一步分析A組與B組資料,總失血量、顯性失血量、隱性失血量、輸血率、住院天數(shù)、深靜脈栓塞事件及出血并發(fā)癥等資料有無(wú)統(tǒng)計(jì)學(xué)差異；A組與C組相比,總失血量、顯性失血量、隱性失血量、輸血率、住院天數(shù)、皮下瘀斑率及出血并發(fā)癥等資料有無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)果：經(jīng)統(tǒng)計(jì)分析,三組病例患者的患者性別、年齡、患膝側(cè)別(左右)、身高、體重、體重指數(shù)(Body Mass Index BMI)、年齡組別(小于60歲,大于60歲)、術(shù)前Hss評(píng)分、手術(shù)切口、手術(shù)時(shí)間、術(shù)前血色素、術(shù)前Hct、術(shù)前D二聚體、合并內(nèi)科疾病(高血壓、糖尿病、高血壓及糖尿病、無(wú)高血壓及糖尿病)等資料均無(wú)統(tǒng)計(jì)學(xué)差異性(P0.05),三組資料具備可比性。所有病例失血量所占百分比：顯性失血量所占百分比：27.70±11.35%；隱性失血量所占百分比：72.38±11.26%。A組與B組、A組與C組兩對(duì)照組比較,發(fā)現(xiàn)其顯性失血量所占百分比及隱性失血量所占百分比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。說(shuō)明使用氨甲環(huán)酸或活血化瘀中藥對(duì)TKA術(shù)后顯性失血量所占百分比及隱性失血所占百分比無(wú)明顯影響。根據(jù)圍手術(shù)期監(jiān)測(cè)血常規(guī)情況,發(fā)現(xiàn)術(shù)后三組患者的血色素及Hct平均值最低點(diǎn)主要集中在第三天,術(shù)后第七天趨勢(shì)基本平緩。比較氨甲環(huán)酸對(duì)TKA術(shù)后隱性失血的影響,發(fā)現(xiàn)B組較A組術(shù)后總失血量平均減少211.86ml,隱性失血量平均減少160.28ml,住院天數(shù)平均減少2.4天,(P0.05),差異有統(tǒng)計(jì)學(xué)意義。但顯性失血量、術(shù)后引流量、輸血率及皮下瘀斑率差異無(wú)統(tǒng)計(jì)學(xué)意義。且研究對(duì)象均未出現(xiàn)DVT事件。說(shuō)明氨甲環(huán)酸可以有效減少TKA術(shù)后失血總量、隱性失血量及住院天數(shù),且其安全性良好。比較活血化瘀中藥對(duì)隱性失血的影響,發(fā)現(xiàn)A組較C組總失血量平均增加225.69ml,隱性失血量平均增加167.66ml,(P0.05),差異有統(tǒng)計(jì)學(xué)意義。但顯性失血量、住院天數(shù)、術(shù)后引流量、輸血率及皮下瘀斑率差異無(wú)統(tǒng)計(jì)學(xué)意義。且研究對(duì)象均未出現(xiàn)DVT事件及大失血并發(fā)癥。說(shuō)明活血化瘀中藥在良好的預(yù)防TKA術(shù)后DVT的同時(shí),會(huì)增加TKA術(shù)后失血總量、隱性失血量。結(jié)論：根據(jù)研究結(jié)果發(fā)現(xiàn),隱性失血占有TKA術(shù)后失血量的絕大部分。術(shù)后血色素及Hct最低值主要集中在術(shù)后第三天。氨甲環(huán)酸可明顯減少圍手術(shù)期失血量,減少住院天數(shù),且并未增加DVT風(fēng)險(xiǎn),故氨甲環(huán)酸安全有效,是一種值得推廣的控制圍手術(shù)期失血的藥物。活血化瘀中藥在良好的預(yù)防TKA術(shù)后靜脈栓塞事件的同時(shí),會(huì)增加TKA術(shù)后失血總量、隱性失血量。故使用活血化瘀中藥同時(shí)需密切監(jiān)測(cè)患者血色素情況,及時(shí)補(bǔ)充因隱性失血導(dǎo)致的血容量下降。
[Abstract]:Objective: To evaluate the effect and safety of Total Knee Arthroplasty TKA on recessive hemorrhage (Hidden Blood Loss HB L) for postoperative recessive hemorrhage (Hidden Blood Loss HB L) in patients with total knee replacement (Tranexamic Acid TXA), and to evaluate the effect and safety of the patients with recessive hemorrhage (Hidden Blood Loss HB L) after operation. To prevent deep venous embolism (Deep Vein Thrombosis DVT) and evaluate its effect on postoperative recessive blood loss and its safety, to provide basis for the application of Chinese medicine for activating blood and removing stasis in the perioperative period of artificial joint. A total of 90 cases of unilateral TKA were studied in our hospital, of which group A: group of Chinese medicine for activating blood and removing stasis, 30 cases; group B: group of activating blood and removing blood stasis combined with methicyclic acid treatment group, 30 cases; group C: normal saline control group and 30 cases. All three groups were operated by the same main knife, and the three groups of patients all carried out a consistent rehabilitation exercise plan after the operation. After 2 weeks, the patients were discharged about 2 weeks. Analyze the patient's condition before operation, quantify the data, and then analyze the preoperative data of the three groups by using the statistical software of SPSS17.0, and compare the homogeneity of the samples. If the analysis results suggest that the data of the three groups are comparable, the data of the group A and the group of B are further analyzed and the total blood loss is analyzed. Quantity, dominant blood loss, recessive blood loss, blood transfusion rate, hospitalization days, deep venous embolism events and bleeding complications, and other data were not statistically different. Compared with group C, there were no statistical differences in total blood loss, dominant blood loss, recessive blood loss, blood transfusion rate, hospitalization days, subcutaneous ecchymosis and bleeding complications. Analysis, three groups of cases of patients with sex, age, knee side (left and right), height, weight, body mass index (Body Mass Index BMI), age group (less than 60 years old, more than 60 years old), preoperative Hss score, surgical incision, operation time, preoperative hemoglobin, preoperative Hct, preoperative D two polymer, combined with internal medical diseases (hypertension, diabetes, hypertension and diabetes) There was no statistical difference in the data of disease, hypertension and diabetes mellitus (P0.05). The percentage of all the three groups was comparable. The percentage of all cases of blood loss: the percentage of dominant blood loss was 27.70 + 11.35%, the percentage of recessive blood loss was 72.38 + 11.26%.A and B, and the dominant blood loss was found in group A and C group. The percentage of the percentage and the percentage of recessive blood loss had no significant difference (P0.05). It showed that the percentage of dominant blood loss and the percentage of recessive blood loss were not significantly affected by the use of methicyclic acid or activating blood circulation to remove blood stasis. The hemoglobin and Hct in the three groups of patients after the perioperative period were detected. The mean lowest point was mainly concentrated at third days and the trend of seventh days after operation was basically slow. Comparing the effect of methicinic acid on the recessive blood loss after TKA, it was found that the total loss of blood in group B decreased by 211.86ml, the average loss of recessive blood loss was 160.28ml, the average number of hospitalization days decreased by 2.4 days, (P0.05), but the difference was statistically significant. However, the dominant loss of blood was statistically significant. There was no significant difference in volume, postoperative flow rate, blood transfusion rate and subcutaneous ecchymosis. And no DVT events were found in the subjects. It was suggested that methicyclic acid could effectively reduce the total amount of blood loss, the amount of recessive blood loss and the days of hospitalization, and the safety of the patients after TKA. The comparison of the effect of the Chinese medicine for activating blood and removing stasis on the recessive blood loss was found, and the total loss of blood in the group A was compared with that of the group C. The average increase of 225.69ml, the average amount of recessive blood loss increased by 167.66ml, (P0.05), and the difference was statistically significant. However, there was no significant difference between the dominant blood loss, the days of hospitalization, the postoperative flow rate, the rate of blood transfusion and the subcutaneous ecchymosis. And there were no DVT events and large hemorrhagic complications. DVT also increased the total amount of blood loss and recessive blood loss after TKA. Conclusion: according to the results, recessive blood loss accounts for most of the amount of blood loss after TKA. The postoperative hemoglobin and Hct minimum are mainly concentrated at third days after the operation. Methicinic acid can significantly reduce the perioperative loss of blood, reduce the number of days in hospital, and do not increase the risk of DVT. Therefore, it is a safe and effective drug that is worth popularizing in the perioperative period to control the blood loss in the perioperative period. The Chinese medicine for activating blood and removing stasis can increase the total amount of blood loss and recessive blood loss after the operation of TKA after the operation of TKA, so the use of the Chinese medicine for activating blood and removing stasis needs to monitor the hemoglobin and supplement the recessive situation in time. Blood loss caused by blood loss is decreasing.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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