【摘要】：目的:觀察關(guān)節(jié)腔內(nèi)運(yùn)用氨甲環(huán)酸注射液在骨關(guān)節(jié)炎患者行初次單膝人工關(guān)節(jié)置換術(shù)后對(duì)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(xué)第二附屬醫(yī)院骨關(guān)節(jié)科接受膝關(guān)節(jié)行單側(cè)初次骨水泥全膝關(guān)節(jié)置換術(shù)的患者為研究對(duì)象。排除標(biāo)準(zhǔn)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(duì)抗凝類藥物過敏術(shù)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(shù)后的患者;術(shù)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(jī)平均分為氨甲環(huán)酸組和對(duì)照組兩組,每組48例。兩組術(shù)后均常規(guī)留置引流管,氨甲環(huán)酸組關(guān)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(duì)照組關(guān)節(jié)腔注射50ml生理鹽水。兩組術(shù)后都夾閉引流管3 h后放開引流。術(shù)后24小時(shí)、72小時(shí)抽取靜脈血檢測(cè)紅細(xì)胞壓積、血紅蛋白、凝血酶原時(shí)間、活化部分凝血活酶時(shí)間;記錄術(shù)后12小時(shí)引流量、24小時(shí)引流量、48小時(shí)引流量;計(jì)算顯性失血量;檢查患者術(shù)后是否有血栓形成。數(shù)據(jù)采用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,連續(xù)型變量采用t檢驗(yàn),分類變量采用兩獨(dú)χ2檢驗(yàn)。如果P0.05則認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、兩組患者年齡、性別、身高、體質(zhì)指數(shù)、PT、APTT水平比較、術(shù)前血紅蛋白、術(shù)前HCT,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。2、氨甲環(huán)酸組的19例(39.5%),對(duì)照組的34例(70.8%)接受了輸血治療。3、兩組術(shù)后血紅蛋白(Hemoglobin,HB)及紅細(xì)胞壓積(Hematocrit,HCT)比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);4、氨甲環(huán)酸組患者術(shù)后顯性失血量氨甲環(huán)酸組平均為512ml,對(duì)照組平均為975ml;術(shù)后總引流量甲環(huán)酸組平均為354ml,對(duì)照組平均為805ml;12小時(shí)引流量氨甲環(huán)酸組平均為284ml,對(duì)照組平均為565ml;24小時(shí)引流量氨甲環(huán)酸組平均為60ml,對(duì)照組平均為161ml;48小時(shí)引流量氨甲環(huán)酸組平均為9ml,對(duì)照組平均為75ml。各項(xiàng)數(shù)值表明氨甲環(huán)酸組較對(duì)照組均減少(P0.05)。5、氨甲環(huán)酸組與對(duì)照組手術(shù)切口均I期愈合,兩組經(jīng)觀察均無嚴(yán)重不良反應(yīng)和并發(fā)癥發(fā)生。結(jié)論:經(jīng)過本實(shí)驗(yàn)的觀察發(fā)現(xiàn)在使用氨甲環(huán)酸后術(shù)后的失血量及輸血率有明顯的降低,并且未發(fā)現(xiàn)嚴(yán)重并發(fā)癥。所以初次全膝人工關(guān)節(jié)置換術(shù)后關(guān)節(jié)腔內(nèi)局部應(yīng)用氨甲環(huán)酸是一種操作簡(jiǎn)單、安全有效的減少術(shù)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(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 徐林;向柄彥;柏小金;黃文良;呂雪峰;李鵬;;人工半髖關(guān)節(jié)置換術(shù)治療15例高齡不穩(wěn)定股骨轉(zhuǎn)子間骨折的療效[J];重慶醫(yī)學(xué);2014年07期

2 張蕾蕾;劉又文;;人工髖關(guān)節(jié)置換術(shù)后并發(fā)癥的研究綜述[J];風(fēng)濕病與關(guān)節(jié)炎;2014年03期

3 游戊己;林曉毅;袁華澄;;全膝關(guān)節(jié)置換術(shù)后切口愈合不良的臨床研究[J];中國(guó)骨與關(guān)節(jié)損傷雜志;2014年04期

4 劉冰;;半髖關(guān)節(jié)置換術(shù)改善老年股骨頸骨折患者髖關(guān)節(jié)功能的效果觀察[J];中國(guó)醫(yī)藥科學(xué);2014年15期

5 陸麗娟;許勤;秦芳艷;;全膝關(guān)節(jié)置換術(shù)后患者康復(fù)問題的研究進(jìn)展[J];中國(guó)骨與關(guān)節(jié)雜志;2014年09期

6 夏玉斌;;惡性骨腫瘤保肢手術(shù)患者的康復(fù)護(hù)理[J];當(dāng)代護(hù)士(下旬刊);2015年09期

7 羅肖;陳敬忠;張懷學(xué);蘇鵬;;髖關(guān)節(jié)置換術(shù)后發(fā)生早期脫位的危險(xiǎn)因素分析[J];局解手術(shù)學(xué)雜志;2014年01期

8 范貴富;羅勇;徐向偉;梁毅;劉鴻;;初次人工髖關(guān)節(jié)置換術(shù)后假體脫位原因分析及預(yù)防[J];華西醫(yī)學(xué);2014年01期

9 傅東明;牟傳勇;周長(zhǎng)明;;同種異體皮質(zhì)骨板在股骨翻修中的應(yīng)用[J];中外醫(yī)療;2014年04期

10 王艷敏;;健康教育路徑在老年患者髖關(guān)節(jié)置換術(shù)后的應(yīng)用[J];護(hù)理實(shí)踐與研究;2014年08期

相關(guān)博士學(xué)位論文 前1條

1 陸博;應(yīng)用超聲成像技術(shù)評(píng)價(jià)坐骨股骨間隙及其影響因素的相關(guān)研究[D];河北醫(yī)科大學(xué);2015年

相關(guān)碩士學(xué)位論文 前10條

1 鞠云飛;國(guó)產(chǎn)人工關(guān)節(jié)治療股骨頭缺血性壞死的臨床觀察[D];山東中醫(yī)藥大學(xué);2013年

2 萬睿;紗布纖維與聚乙，

本文編號(hào)：2232523