本文選題：氨甲環(huán)酸 + 類(lèi)風(fēng)濕關(guān)節(jié)炎�。� 參考：《東南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年02期

【摘要】：目的:研究氨甲環(huán)酸對(duì)類(lèi)風(fēng)濕關(guān)節(jié)炎患者全髖關(guān)節(jié)置換圍術(shù)期失血的影響。方法:回顧性分析我院2013年4月至2015年7月期間157例因類(lèi)風(fēng)濕關(guān)節(jié)炎(steinbrocker 3、4級(jí))行初次全髖關(guān)節(jié)置換術(shù)患者的臨床資料,其中對(duì)照組40例未使用氨甲環(huán)酸,單次給藥組56例在術(shù)前20 min靜脈滴注氨甲環(huán)酸15 mg·kg~(-1),重復(fù)給藥組61例在單次給藥組基礎(chǔ)上于術(shù)后3 h再次靜脈滴注氨甲環(huán)酸10 mg·kg~(-1)。比較3組術(shù)后總失血量、輸血率、深靜脈血栓、肺栓塞發(fā)生率、凝血指標(biāo)、術(shù)后引流量、術(shù)后血紅蛋白下降值及并發(fā)癥情況。結(jié)果:與對(duì)照組比較,重復(fù)給藥組和單次給藥組總失血量、術(shù)后引流量及術(shù)后第3天血紅蛋白減少值均顯著變小,差異具有統(tǒng)計(jì)學(xué)意義(均P0.05);與單次給藥組比較,重復(fù)給藥組術(shù)后總失血量、引流量及術(shù)后第3天血紅蛋白減少值均進(jìn)一步減小,差異具有統(tǒng)計(jì)學(xué)意義(均P0.05)。重復(fù)給藥組術(shù)后輸血率明顯低于對(duì)照組(P0.05)。術(shù)后3組患者均未發(fā)生深靜脈血栓及肺栓塞,且術(shù)后凝血指標(biāo)組間比較均無(wú)顯著差異(均P0.05)。單次給藥組7例、重復(fù)給藥組5例、對(duì)照組6例出現(xiàn)切口并發(fā)癥,組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:氨甲環(huán)酸靜脈滴注可有效降低類(lèi)風(fēng)濕關(guān)節(jié)炎患者全髖關(guān)節(jié)置換圍術(shù)期總失血量與輸血率,且不增加血栓及并發(fā)癥的發(fā)生。另外,術(shù)前及術(shù)后3 h重復(fù)給藥作用優(yōu)于術(shù)前單次使用氨甲環(huán)酸。
[Abstract]:Objective: to study the effect of methionine on perioperative blood loss in patients with rheumatoid arthritis (RA) after total hip arthroplasty (THR). Methods: the clinical data of 157 patients with rheumatoid arthritis (steinbrocker 3 grade 4) undergoing primary total hip arthroplasty in our hospital from April 2013 to July 2015 were retrospectively analyzed. 56 patients in the single administration group were intravenously injected with 15 mg kg ~ (-1) of methacylic acid 20 min before operation, and 61 cases in the repeated administration group were given 10 mg kg ~ (-1) of methacylic acid intravenously on the basis of a single dose of the drug at 3 h after operation. The total blood loss, blood transfusion rate, deep vein thrombosis, pulmonary embolism, coagulation index, postoperative drainage volume, hemoglobin decrease and complications were compared among the three groups. Results: compared with the control group, the total blood loss, postoperative drainage volume and hemoglobin reduction on the third day were significantly smaller in the repeated administration group and the single dose group (P0.05), and compared with the single dose group, the difference was significant (P0.05). In the repeated administration group, the total blood loss, drainage volume and hemoglobin reduction on the 3rd day after operation were further reduced, and the difference was statistically significant (P0.05). The blood transfusion rate in the repeated administration group was significantly lower than that in the control group (P0.05). No deep venous thrombosis or pulmonary embolism occurred in the three groups after operation, and there was no significant difference in coagulation indexes between the three groups (P0.05). There were 7 cases in the single administration group, 5 cases in the repeated administration group and 6 cases in the control group. There was no significant difference between the two groups (P0.05). Conclusion: the total blood loss and blood transfusion rate of total hip replacement in patients with rheumatoid arthritis can be effectively reduced by intravenous infusion of ammonia methocycline, and the incidence of thrombosis and complications is not increased. In addition, the effect of repeated administration before operation and 3 hours after operation was better than that of single use of carbamicylic acid before operation.
【作者單位】： 常州市中醫(yī)醫(yī)院骨科;
【基金】：江蘇省自然科學(xué)基金資助項(xiàng)目(BK20131485) 常州市科技計(jì)劃項(xiàng)目(CJ20141205)
【分類(lèi)號(hào)】：R593.22;R687.4

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