【摘要】：目的:通過建立人工膝關(guān)節(jié)置換動物模型,觀察使用氨甲環(huán)酸后早期圍手術(shù)期失血的變化,探討氨甲環(huán)酸對隱性失血的作用以及對下肢深靜脈血栓的影響。方法:自行設(shè)計完成兔膝關(guān)節(jié)假體,20只成年新西蘭兔隨機分成兩組,每組10只,均進行同一側(cè)膝關(guān)節(jié)置換術(shù),實驗組在術(shù)前15min給予0.5g 100ml的氨甲環(huán)酸靜滴,對照組于相同時間給予100ml 0.9%的氯化鈉,所有實驗動物于術(shù)前一天12-14h,術(shù)后3h、6h、24h、48h、72h、第7天分別進行耳緣靜脈采血,進行多次血常規(guī)及凝血功能的檢查,測定血漿D-D二聚體的含量,同時記錄手術(shù)時間及計算術(shù)中出血量,統(tǒng)一行統(tǒng)計學(xué)分析,術(shù)后進行下肢靜脈超聲檢查的篩選。結(jié)果:實驗組和對照組術(shù)前體重、血紅蛋白、紅細胞壓積和D-D二聚體無明顯差異(p0.05)。手術(shù)時間以及術(shù)中顯性失血量的差異具有顯著性意義(p0.05),術(shù)后24h的血紅蛋白和紅細胞壓積值經(jīng)比較有明顯差異(p0.05),兩組術(shù)后D-D二聚體沒有差異性(p0.05),手術(shù)時間、術(shù)中顯性失血與術(shù)后24h的血紅蛋白、紅細胞壓積值具有明顯相關(guān)性(p0.05),與術(shù)后72h、第7天的血紅蛋白、紅細胞壓積值的變化和圍手術(shù)期D-D二聚體的變化無明顯相關(guān)性。術(shù)后下肢靜脈超聲檢查無一例出現(xiàn)明顯的血栓。結(jié)論:本文通過建立人工膝關(guān)節(jié)置換動物模型,觀察使用氨甲環(huán)酸后早期圍手術(shù)期失血的變化,結(jié)果顯示氨甲環(huán)酸術(shù)前的使用可以明顯減少術(shù)中顯性失血,縮短手術(shù)時間,能夠顯著減少術(shù)后第一天的隱性失血量,這是由于手術(shù)應(yīng)激后纖維蛋白溶解增加引起的失血進入到第三組織間隙,對非該機理引起的其他隱性失血無明顯作用。同時它的安全性可靠,不增加圍手術(shù)期血栓風(fēng)險。本實驗為氨甲環(huán)酸的臨床使用提供理論依據(jù),為探索隱性失血的機制提供幫助。
[Abstract]:Objective: to establish an artificial knee replacement animal model to observe the changes of early perioperative blood loss and to explore the effect of tranexamic acid on recessive blood loss and on deep venous thrombosis of lower extremity. Methods: a total of 20 adult New Zealand rabbits were randomly divided into two groups (10 rabbits in each group) with the same knee arthroplasty. The experimental group was given 0.5 g 15min intravenously before operation. The control group was given 0.9% sodium chloride of 100ml at the same time. All the experimental animals received blood samples from auricular vein at 12 to 14 hours before operation and from 24 hours to 48 hours after operation. On the 7th day, the blood samples were collected from the auricular vein, and the blood routine and coagulation function were examined for several times, and the plasma D-D dimer content was measured. At the same time, the time of operation and the amount of intraoperative bleeding were recorded. Results: there was no significant difference in weight, hemoglobin, hematocrit and D-D dimer between the experimental group and the control group (p0.05). The time of operation and the amount of dominant blood loss were significantly different (p0.05). The hemoglobin and hematocrit were significantly different at 24 hours after operation (p0.05). There was no difference between the two groups in D-D dimer (p0.05). There was a significant correlation between hemoglobin and hematocrit at 24 hours after operation (p0.05). There was no significant correlation with hemoglobin and hematocrit at 72 hours and 7 days after operation and the changes of D-D dimer in perioperative period. There was no obvious thrombus in lower extremity venous ultrasound after operation. Conclusion: the animal model of artificial knee arthroplasty was established to observe the changes of perioperative blood loss in the early perioperative period after the use of carbamate. The results showed that the preoperative use of carbamate could significantly reduce the apparent blood loss during operation and shorten the operation time. It can significantly reduce the amount of recessive blood loss on the first day after operation, which is due to the increase of fibrinolysis after operation and the blood loss into the third tissue space, but has no obvious effect on other recessive blood loss caused by this mechanism. At the same time, it is safe and reliable, and does not increase the perioperative risk of thrombus. This experiment provides a theoretical basis for the clinical use of methachloroic acid and helps to explore the mechanism of recessive blood loss.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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