發(fā)布時(shí)間：2018-08-23 21:31

【摘要】：目的:比較在全膝關(guān)節(jié)置換圍術(shù)期多次使用氨甲環(huán)酸較單次使用氨甲環(huán)酸的有效性和安全性。方法:回顧性收集我院2016年8月到2016年12月期間行初次單側(cè)全膝關(guān)節(jié)置換的病人的臨床數(shù)據(jù)。我科在2016年8月到2016年10月期間,手術(shù)前30min單次靜脈滴注氨甲環(huán)酸1.5g;2016年11月到2016年12月期間,為進(jìn)一步減少患者術(shù)中、術(shù)后失血,將單次使用氨甲環(huán)酸改為多次使用:分別為術(shù)前30min1.5g靜脈滴注,術(shù)中關(guān)閉手術(shù)切口前1g局部注射,手術(shù)結(jié)束后3h,12h,24h,48h,72h各1g靜脈滴注。比較兩個(gè)階段病人的總失血量,術(shù)后不同時(shí)間血紅蛋白、輸血患者比例、凝血象、深靜脈血栓和肺栓塞等栓塞性事件的發(fā)生率,以及C反應(yīng)蛋白,血沉等炎癥指標(biāo)。結(jié)果:和先前的單次使用氨甲環(huán)酸相比,總失血量:多次使用組患者為(499.56±244.2m1),單次使用組患者為(764.47±311.35m1),(P0.001);隱性失血量:多次使用組為(309.65±42.67 m1),單次使用組為(480.23±46.28 m1),(P0.001);術(shù)后引流量:多次使用組為(46.87±12.31m1),單次使用組為(135.64±95.32m1),(P0.001);術(shù)后血紅蛋白下降最大值:多次使用組為(15.67±8.94 g/L),單次使用組為(26.64±11.04 g/L)(P0.001);上述比較可見(jiàn)多次使用組均較單次使用組低,且有統(tǒng)計(jì)學(xué)差異。而關(guān)于凝血象、輸血率、深靜脈血栓和肺栓塞的發(fā)生率,單次使用與多次使用組之間未見(jiàn)明顯差異。和單次使用氨甲環(huán)酸組相比,多次使用氨甲環(huán)酸的患者的C反應(yīng)蛋白,血沉在術(shù)后的第1、3、5 d均低于單次使用患者。結(jié)論:在全膝關(guān)節(jié)置換術(shù)中,與單次使用氨甲環(huán)酸相比,多次使用氨甲環(huán)酸有助于進(jìn)一步有效降低患者的總失血量,減少患者術(shù)后第1、3、5 d的血紅蛋白的丟失,持續(xù)降低患者術(shù)后的炎癥反應(yīng)強(qiáng)度,同時(shí)不增加血栓形成風(fēng)險(xiǎn)。
[Abstract]:Objective: to compare the efficacy and safety of multiple use of methachlorocylic acid in perioperative period of total knee arthroplasty. Methods: the clinical data of patients undergoing first unilateral total knee arthroplasty from August 2016 to December 2016 were collected retrospectively. During the period from August 2016 to October 2016, 30min was given a single intravenous drip of 1.5 g of carbamoic acid between August 2016 and October 2016. From November 2016 to December 2016, in order to further reduce the blood loss during and after operation, The single use of carbamoic acid was changed into multiple use: preoperative 30min1.5g intravenous drip, 1 g local injection before closing the surgical incision during the operation, and 1 g intravenous drip 3 h after operation at 12 h, 24 h, 48 h and 72 h, respectively. The total blood loss, hemoglobin at different time after operation, the proportion of blood transfusion patients, the incidence of thromboembolism, deep vein thrombosis and pulmonary embolism, and inflammatory indexes such as C-reactive protein and erythrocyte sedimentation were compared between the two stages. Results: compared with previous single use of carbamate, Total blood loss: multiple use group (499.56 鹵244.2m1), single use group (764.47 鹵311.35m1), (P0.001), occult blood loss: multiple use group (309.65 鹵42.67ml), single use group (480.23 鹵46.28ml), (P0.001), postoperative drainage volume: multiple use group (46.87 鹵12.31m1), single use group (135.64 鹵95.32m1), (P0.001), postoperative blood loss volume: multiple use group (46.87 鹵12.31m1), single use group (135.64 鹵95.32m1), (P0.001), postoperative blood loss volume (309.65 鹵42.67m-1), postoperative drainage volume: multiple use group (46.87 鹵12.31m1), single use group (135.64 鹵95.32m1), (P0.001); The maximum white drop was (15.67 鹵8.94 g / L) in multiple use group and (26.64 鹵11.04 g / L) in single use group (P0.001). And there is statistical difference. There was no significant difference in coagulation, blood transfusion rate, deep venous thrombosis and pulmonary embolism between single and multiple use groups. Compared with the single group, the erythrocyte sedimentation rate (ESR) of the patients with multiple use of carbamate was significantly lower than that of the patients who were given monocycline on the 1st day after operation. Conclusion: in total knee arthroplasty, compared with single use of carbonic acid, repeated use of carbamoic acid can further reduce the total blood loss and hemoglobin loss of the patients at the 3rd day after operation. Sustained reduction of postoperative inflammatory response without increased risk of thrombosis.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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