本文選題：全膝關(guān)節(jié)置換術(shù) + 負壓引流��； 參考：《浙江大學(xué)》2015年博士論文

【摘要】：研究目的： 分析比較全膝關(guān)節(jié)置換術(shù)后兩種不同引流方式的臨床療效,為TKA術(shù)后引流方式的選擇提供一定的參考價值。 研究方法： 回顧性收集2014年1月1日至2015年3月1日于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院骨科病區(qū)關(guān)節(jié)組住院治療并由同一治療小組行“全膝關(guān)節(jié)置換術(shù)”的94例患者(主要診斷為膝骨關(guān)節(jié)炎或者類風(fēng)濕性關(guān)節(jié)炎)的臨床資料。94例患者術(shù)后均放置引流管接600m1負壓引流瓶,根據(jù)引流方式不同分為A、B兩組,其中2014年8月1日至2015年3月1日期間行TKA手術(shù)治療的44例患者為A組(男12例,女32例),該組患者術(shù)中釋放引流瓶中負壓,不予夾管,常壓下引流至次日早上9點,而后用50m1針筒抽成負壓(50m1針筒抽10次)繼續(xù)負壓引流直至拔管；2014年1月1日至2014年7月31日期間行TKA手術(shù)治療的50例患者為B組(男18例,女32例),該組患者手術(shù)結(jié)束后使用與A組相同的負壓引流瓶,術(shù)后夾閉4h后打開引流管,持續(xù)負壓引流直至拔管。利用統(tǒng)計軟件分析比較兩組患者術(shù)后引流量、輸血量、術(shù)后總出血量、術(shù)后住院時間、感染比例、血栓發(fā)生比例等指標,得出結(jié)論。 研究結(jié)果： 1. A組術(shù)后6h常壓下引流量為31.25±28.12ml,B組夾閉4h后打開引流管,術(shù)后6h計量引流瓶中引流量為83.30±69.25ml,P值0.01,差異有顯著統(tǒng)計學(xué)意義。6-12h內(nèi)B組流量(100.59±87.76ml)同樣顯著高于A組(29.7±51.72ml),P0.01,而在12h以后,兩組12-24h (70.07±78.84ml VS67.94±49.35ml)內(nèi)引流量基本一致,差異無統(tǒng)計學(xué)意義,P=0.96。平均拔管時間為38.70±7.23h和37.74±0.81h,P=0.59,差異無統(tǒng)計學(xué)意義。拔管后最終引流量B組(286.10±167.49ml)同樣多于A組(171.30±112.86ml),P0.01,差異具有顯著統(tǒng)計學(xué)意義。 2.A組的術(shù)后輸血量明顯少于B組,差異具有顯著統(tǒng)計學(xué)意義(P0.01)。A組術(shù)后1天丟失的血容量同樣低于B組,P值=0.01差異具有顯著統(tǒng)計學(xué)意義。兩組3天內(nèi)的總失血量無統(tǒng)計學(xué)差別(1191±590ml VS1300±735ml,P=0.68)。兩組其他指標如術(shù)后體溫、術(shù)后CPM機鍛煉情況、術(shù)后感染率、血栓發(fā)生率、術(shù)后住院時間等指標對比均無統(tǒng)計學(xué)差異。 研究結(jié)論： 對于行全膝關(guān)節(jié)置換術(shù)的病人來說,相比較目前廣泛使用的夾閉4h后持續(xù)負壓引流的方式而言,常壓轉(zhuǎn)負壓的引流方式能有效減少術(shù)后引流量和術(shù)后總出血量,并能減少術(shù)后輸血量,兩組對比術(shù)后CPM機鍛煉情況、術(shù)后感染率、血栓發(fā)生率、住院時間等方面無顯著差別。
[Abstract]:Objectives of the study: To analyze and compare the clinical effects of two different drainage methods after total knee arthroplasty, and to provide some reference value for the choice of drainage mode after TKA. Research methods: A retrospective study of 94 cases of total knee arthroplasty performed by the same treatment group from January 1, 2014 to March 1, 2015 in the joint group of the second affiliated Hospital of Zhejiang University School of Medicine was conducted. Clinical data of osteoarthritis or rheumatoid arthritis. 94 patients were treated with drainage tube and 600m1 negative pressure drainage bottle. According to the different drainage methods, the patients were divided into two groups: group A (12 males and 32 females) treated with TKA from August 1, 2014 to March 1, 2015. Drainage under normal pressure until 9 o'clock in the next morning, and then 10 times with 50m1 syringe) continue negative pressure drainage until extubation. 50 patients undergoing TKA operation between January 1, 2014 and July 31, 2014 were in group B (18 men). 32 female patients were treated with the same negative pressure drainage bottle as group A after operation. The drainage tube was opened 4 hours after operation and continued negative pressure drainage until extubation. Statistical software was used to analyze and compare the postoperative drainage volume, blood transfusion volume, postoperative total bleeding volume, postoperative hospitalization time, infection ratio and thrombus incidence ratio between the two groups, and a conclusion was reached. Results of the study: 1. In group A, the drainage flow was 31.25 鹵28.12ml / L group (31.25 鹵28.12ml / L) after being clamped for 4 h, and the volume of drainage flask was 83.30 鹵69.25ml / ml (P = 0.01) at 6 h after operation, which was significantly higher than that in group A (29.7 鹵51.72ml / ml P 0.01) within 6-12 hours. The internal drainage flow was basically the same in the two groups (12-24 h, 70.07 鹵49.35 ml), and there was no significant difference between the two groups (P < 0. 96). The mean extubation time was 38.70 鹵7.23h and 37.74 鹵0.81h, respectively. The final drainage volume after extubation in group B (286.10 鹵167.49 ml) was also higher than that in group A (171.30 鹵112.86 ml, P 0.01), and the difference was statistically significant. 2.The volume of blood transfusion in group A was significantly less than that in group B, and the difference was statistically significant. The blood volume lost in group A was also lower than that in group B (P < 0.01). There was no significant difference in total blood loss within 3 days between the two groups (1191 鹵590ml VS1300 鹵735ml). There was no significant difference in other indexes such as postoperative body temperature, postoperative CPM exercise, postoperative infection rate, thrombus incidence and postoperative hospitalization time between the two groups. The study concluded that: For patients undergoing total knee arthroplasty, compared with the currently widely used method of continuous negative pressure drainage after 4 hours of clamping, atmospheric pressure to negative pressure drainage can effectively reduce postoperative drainage flow and total blood loss. There was no significant difference between the two groups in terms of postoperative CPM machine exercise, postoperative infection rate, thrombus incidence, hospital stay and so on.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R687.4

【參考文獻】

相關(guān)期刊論文 前2條

1 Yu Fan;Yong Liu;Jin Lin;Xiao Chang;Wei Wang;Xi-sheng Weng;Gui-xing Qiu;;Drainage does not Promote Post-operative Rehabilitation After Bilateral Total Knee Arthroplasties Compared With Nondrainage[J];Chinese Medical Sciences Journal;2013年04期

2 陳曉濤;謝守寧;王凱;;人工全膝關(guān)節(jié)置換術(shù)中使用氨甲環(huán)酸的療效研究[J];中國修復(fù)重建外科雜志;2014年11期

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本文編號：1977312