發(fā)布時間：2018-09-09 13:31

【摘要】：目的:觀察關節(jié)腔內(nèi)運用氨甲環(huán)酸注射液在骨關節(jié)炎患者行初次單膝人工關節(jié)置換術后對失血量的影響。方法:選取2014年1月~2015年3月于山西醫(yī)科大學第二附屬醫(yī)院骨關節(jié)科接受膝關節(jié)行單側初次骨水泥全膝關節(jié)置換術的患者為研究對象。排除標準為:目前口服或皮下注射抗凝類藥物,入院后檢查凝血系列提示異常的患者,伴隨血液系統(tǒng)疾病的患者,對抗凝類藥物過敏術后不能抗血栓治療的患者;既往有血栓病史或房顫、心臟起搏器和支架植入術后的患者;術前血紅蛋白低于90g/L的患者。共96例患者納入本研究,將其隨機平均分為氨甲環(huán)酸組和對照組兩組,每組48例。兩組術后均常規(guī)留置引流管,氨甲環(huán)酸組關節(jié)腔注射50ml氨甲環(huán)酸注射液(規(guī)格為100ml含1g氨甲環(huán)酸和0.7g氯化鈉),對照組關節(jié)腔注射50ml生理鹽水。兩組術后都夾閉引流管3 h后放開引流。術后24小時、72小時抽取靜脈血檢測紅細胞壓積、血紅蛋白、凝血酶原時間、活化部分凝血活酶時間;記錄術后12小時引流量、24小時引流量、48小時引流量;計算顯性失血量;檢查患者術后是否有血栓形成。數(shù)據(jù)采用SPSS13.0統(tǒng)計軟件進行統(tǒng)計學分析,連續(xù)型變量采用t檢驗,分類變量采用兩獨χ2檢驗。如果P0.05則認為差異有統(tǒng)計學意義。結果:1、兩組患者年齡、性別、身高、體質指數(shù)、PT、APTT水平比較、術前血紅蛋白、術前HCT,差異均無統(tǒng)計學意義(P0.05)。2、氨甲環(huán)酸組的19例(39.5%),對照組的34例(70.8%)接受了輸血治療。3、兩組術后血紅蛋白(Hemoglobin,HB)及紅細胞壓積(Hematocrit,HCT)比較,差異有統(tǒng)計學意義(P0.05);4、氨甲環(huán)酸組患者術后顯性失血量氨甲環(huán)酸組平均為512ml,對照組平均為975ml;術后總引流量甲環(huán)酸組平均為354ml,對照組平均為805ml;12小時引流量氨甲環(huán)酸組平均為284ml,對照組平均為565ml;24小時引流量氨甲環(huán)酸組平均為60ml,對照組平均為161ml;48小時引流量氨甲環(huán)酸組平均為9ml,對照組平均為75ml。各項數(shù)值表明氨甲環(huán)酸組較對照組均減少(P0.05)。5、氨甲環(huán)酸組與對照組手術切口均I期愈合,兩組經(jīng)觀察均無嚴重不良反應和并發(fā)癥發(fā)生。結論:經(jīng)過本實驗的觀察發(fā)現(xiàn)在使用氨甲環(huán)酸后術后的失血量及輸血率有明顯的降低,并且未發(fā)現(xiàn)嚴重并發(fā)癥。所以初次全膝人工關節(jié)置換術后關節(jié)腔內(nèi)局部應用氨甲環(huán)酸是一種操作簡單、安全有效的減少術后出血的方式。
[Abstract]:Objective: to observe the effect of intraarticular methacylic acid injection on blood loss in patients with osteoarthritis after primary arthroplasty. Methods: from January 2014 to March 2015, the patients undergoing unilateral cement total knee arthroplasty in the Department of Orthopaedics and Joint of the second affiliated Hospital of Shanxi Medical University were selected as the study objects. The exclusion criteria were as follows: at present, anticoagulant drugs were injected orally or subcutaneously, patients with abnormal coagulation series were examined after admission, patients with diseases of the blood system, patients with anticoagulant allergies who could not be treated with antithrombotic therapy after operation; Patients with previous history of thrombus or atrial fibrillation, pacemaker and stent implantation; patients with preoperative hemoglobin lower than 90g/L. A total of 96 patients were randomly divided into two groups (48 cases in each group). 50ml was injected into the articular cavity of the two groups (100ml contained 1 g methocylic acid and 0.7 g sodium chloride), and the control group was injected with 50ml normal saline. The drainage tube was clamped for 3 hours after operation in both groups. Venous blood was collected 24 hours and 72 hours after operation to detect hematocrit, hemoglobin, prothrombin time and activated partial thromboplastin time. Check for thrombosis after operation. The data were analyzed by SPSS13.0 software. T test was used for continuous variables and 蠂 2 test was used for classification variables. If P0.05, the difference is statistically significant. Results: 1. Age, sex, height, body mass index (BMI) and PTT APTT were compared between the two groups. There was no significant difference in preoperative HCT, between the two groups (P0.05). There were 19 cases (39.5%) in the methacylic acid group and 34 cases (70.8%) in the control group received blood transfusion therapy. The hemoglobin (Hemoglobin,HB) and hematocrit (Hematocrit,HCT) were compared between the two groups. The difference was statistically significant (P0.05). The mean amount of dominant blood loss was 512ml in the methoxycylic acid group and 975ml in the control group, and the mean flow rate was 354ml in the total drainage group and 805ml / 12h in the control group. The average flow rate of the control group was 565 ml / 24 h, the mean flow rate of the control group was 60 ml / 24 hours, the mean value of the control group was 161ml / 48 h, the mean value of the control group was 9 ml and the control group's average was 75 ml / min. All the values showed that the number of methacylic acid group was lower than that of the control group (P0.05). The operation incision of the two groups were healed in the first stage, and no serious adverse reactions and complications occurred in the two groups. Conclusion: the blood loss and blood transfusion rate were significantly decreased and no serious complications were found. Therefore, local intraarticular application of carbamoic acid is a simple, safe and effective way to reduce postoperative bleeding after primary total knee arthroplasty.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4

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本文編號：2232523