多模式方案對減少單膝關(guān)節(jié)置換圍手術(shù)期失血及術(shù)后膝關(guān)節(jié)功能的影響
發(fā)布時間：2019-06-09 12:29
【摘要】：目的:為達到降低單側(cè)全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)圍手術(shù)期失血量、減低術(shù)后輸血率而采用的多模式方案的有效及安全性的探討研究。方法:將于2013年1月~4月我科行單側(cè)全膝關(guān)節(jié)置換的98例符合標準的患者隨機分為采用多模式方案減少圍手術(shù)期失血的49名患者為A組,未采用該方案的49名患者為B組,術(shù)前所有患者均完善血常規(guī)、凝血像、雙下肢靜脈彩超等檢查。多模式止血方案包括:術(shù)前血紅蛋白濃度的優(yōu)化,靜脈用氨甲環(huán)酸,雞尾酒混合劑術(shù)中關(guān)節(jié)內(nèi)外的運用,術(shù)中關(guān)節(jié)內(nèi)局部用氨甲環(huán)酸并且引流管夾閉3h,術(shù)后48h內(nèi)手術(shù)切口外冰敷及患肢髖關(guān)節(jié)和膝關(guān)節(jié)屈曲抬高等方案。兩組患者在性別組成、體重指數(shù)(body mass index,BMI)等術(shù)前基線資料比較無統(tǒng)計學意義。記錄所有患者術(shù)中出血量等數(shù)據(jù)并于術(shù)后復(fù)查血常規(guī)記錄血紅蛋白(Hb)、紅細胞壓積(Hct)的具體數(shù)值,當術(shù)后Hb80g/L時或有明顯貧血癥狀給予輸血,根據(jù)公式計算術(shù)后隱性失血量、顯性失血量等指標;測量術(shù)后第1、2、4周膝關(guān)節(jié)髕骨上、下極相距10厘米及髕骨上極處周徑作為評估腫脹指標及術(shù)后6、24、48、72h用VAS疼痛評分標準評價術(shù)后膝關(guān)節(jié)疼痛情況,用匹茲堡睡眠質(zhì)量指數(shù)(Pittsburg sleep quality index,PSQI)作為所有患者圍手術(shù)期睡眠質(zhì)量的評估標準。術(shù)后7、14天及第1、6、12、18月以KSS評分標準評估膝關(guān)節(jié)功能情況和膝關(guān)節(jié)活動度并記錄,同時觀察患者術(shù)后深靜脈血栓形成等嚴重并發(fā)癥情況,術(shù)后懷疑下肢深靜脈血栓者行下肢深靜脈B超排除。結(jié)果:兩組患者術(shù)前資料具有可比性,A組患者術(shù)后引流量、圍手術(shù)期總失血量等指標均顯著低于B組,A組術(shù)后第1天、3天患者Hb和Hct的降低值小于B組患者(P0.05);術(shù)后輸血A組0例,B組10例(27.77%),B組平均輸紅細胞111.11ml,兩組相比輸血率差異有統(tǒng)計學意義(P0.05);除術(shù)后第一天夜間睡眠質(zhì)量兩組間無差異(P0.05),余A組睡眠質(zhì)量均優(yōu)于B組(P0.05);術(shù)后A組患肢腫脹較B組患者改善(P0.05);術(shù)后6h的VAS評分無統(tǒng)計學意義(P0.05),但術(shù)后24、48、72h的VAS評分A組較B組明顯減少(P0.05);術(shù)后第7、14、30天的KSS評分和膝關(guān)節(jié)活動度A組均優(yōu)于B組(P0.05),但是術(shù)后6、12、18月的KSS評分兩組無明顯差異(P0.05)。隨訪18個月,A組與B組患者均未發(fā)現(xiàn)深靜脈血栓及相關(guān)并發(fā)癥。結(jié)論:多模式方案對減少單膝TKA術(shù)后血液丟失效果顯著甚至達到零輸血率的目標,可以減輕TKA術(shù)后早期患肢腫脹情況緩解術(shù)后早期疼痛改善患者術(shù)后睡眠質(zhì)量,并促進TKA患者早期KSS評分和膝關(guān)節(jié)功能的恢復(fù),同時并不增加相關(guān)并發(fā)癥的發(fā)生,該多模式方案安全、有效、經(jīng)濟、簡單。
[Abstract]:Objective: to study the effectiveness and safety of multimode regimen to reduce perioperative blood loss and postoperative transfusion rate in unilateral total knee arthroplasty (total knee arthroplasty,TKA). Methods: from January to April 2013, 98 patients who met the standard of unilateral total knee arthroplasty were randomly divided into group A (49 patients with multi-mode regimen to reduce perioperative blood loss) and group B (49 patients without this regimen). Before operation, all patients improved blood routine, coagulation image, lower extremity vein color Doppler ultrasound and so on. The multimode hemostatic scheme included the optimization of hemoglobin concentration before operation, the internal and external use of carbamecarboxylic acid and cocktail mixture during operation, the local use of carbamate in the joint during the operation and the clamping of the drainage tube for 3 hours. Within 48 hours after operation, the external ice compress of the incision and the flexion and elevation of the hip joint and knee joint of the affected limb were performed. There was no significant difference in preoperative baseline data such as sex composition and body mass index (body mass index,BMI) between the two groups. The intraoperative blood loss and other data of all patients were recorded and the specific values of hemoglobin (Hb), hematocrit (Hct) were recorded by blood routine review after operation. When Hb80g/L was performed after operation, blood transfusion was given with obvious anemia symptoms. According to the formula, the hidden blood loss and dominant blood loss after operation were calculated. The distance between the upper and lower poles of the patella and the circumference of the upper pole of the patella were measured at the 1st, 2nd and 4th week after operation as the index of swelling and the pain of the knee joint was evaluated by VAS pain score at 72 h after operation. Pittsburgh sleep quality index (Pittsburg sleep quality index,PSQI) was used as the evaluation standard of perioperative sleep quality in all patients. The function of knee joint and the range of motion of knee joint were evaluated and recorded by KSS score standard at 7, 14 days and 1,6 months after operation, and the serious complications such as deep venous thrombosis were observed at the same time. Patients with suspected deep venous thrombosis of lower extremity were excluded by B-ultrasound. Results: the preoperative data of the two groups were comparable. The postoperative drainage volume and the total blood loss in group A were significantly lower than those in group B. the decrease of Hb and Hct in group A was lower than that in group B on the 1st and 3rd day after operation (P 0.05). There were 0 cases in group A and 10 cases in group B (27.77%), B group). There was significant difference in the transfusion rate between the two groups (P 0.05). Except that there was no difference in sleep quality between the two groups on the first day after operation (P 0.05), the sleep quality in group A was better than that in group B (P 0.05), and the swelling of affected limbs in group A was better than that in group B (P 0.05). There was no significant difference in VAS score at 6 h after operation (P 0.05), but the VAS score in group A was significantly lower than that in group B at 24 h, 48 h and 72 h after operation (P 0.05). On the 7th, 14th and 30th day after operation, the KSS score and knee motion in group A were better than those in group B (P 0.05), but there was no significant difference in KSS score between the two groups at 6 months, 12 months and 18 months after operation (P 0.05). Follow-up for 18 months showed no deep venous thrombosis and related complications in group A and group B. Conclusion: the multimode regimen has a significant effect on reducing blood loss after one knee TKA and even achieves the goal of zero blood transfusion rate, which can reduce the swelling of affected limbs in the early stage after TKA, relieve the early pain after operation, and improve the sleep quality of patients after operation. It also promotes the recovery of early KSS score and knee joint function in patients with TKA, and does not increase the occurrence of related complications. The multi-mode regimen is safe, effective, economical and simple.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4
本文編號：2495557
[Abstract]:Objective: to study the effectiveness and safety of multimode regimen to reduce perioperative blood loss and postoperative transfusion rate in unilateral total knee arthroplasty (total knee arthroplasty,TKA). Methods: from January to April 2013, 98 patients who met the standard of unilateral total knee arthroplasty were randomly divided into group A (49 patients with multi-mode regimen to reduce perioperative blood loss) and group B (49 patients without this regimen). Before operation, all patients improved blood routine, coagulation image, lower extremity vein color Doppler ultrasound and so on. The multimode hemostatic scheme included the optimization of hemoglobin concentration before operation, the internal and external use of carbamecarboxylic acid and cocktail mixture during operation, the local use of carbamate in the joint during the operation and the clamping of the drainage tube for 3 hours. Within 48 hours after operation, the external ice compress of the incision and the flexion and elevation of the hip joint and knee joint of the affected limb were performed. There was no significant difference in preoperative baseline data such as sex composition and body mass index (body mass index,BMI) between the two groups. The intraoperative blood loss and other data of all patients were recorded and the specific values of hemoglobin (Hb), hematocrit (Hct) were recorded by blood routine review after operation. When Hb80g/L was performed after operation, blood transfusion was given with obvious anemia symptoms. According to the formula, the hidden blood loss and dominant blood loss after operation were calculated. The distance between the upper and lower poles of the patella and the circumference of the upper pole of the patella were measured at the 1st, 2nd and 4th week after operation as the index of swelling and the pain of the knee joint was evaluated by VAS pain score at 72 h after operation. Pittsburgh sleep quality index (Pittsburg sleep quality index,PSQI) was used as the evaluation standard of perioperative sleep quality in all patients. The function of knee joint and the range of motion of knee joint were evaluated and recorded by KSS score standard at 7, 14 days and 1,6 months after operation, and the serious complications such as deep venous thrombosis were observed at the same time. Patients with suspected deep venous thrombosis of lower extremity were excluded by B-ultrasound. Results: the preoperative data of the two groups were comparable. The postoperative drainage volume and the total blood loss in group A were significantly lower than those in group B. the decrease of Hb and Hct in group A was lower than that in group B on the 1st and 3rd day after operation (P 0.05). There were 0 cases in group A and 10 cases in group B (27.77%), B group). There was significant difference in the transfusion rate between the two groups (P 0.05). Except that there was no difference in sleep quality between the two groups on the first day after operation (P 0.05), the sleep quality in group A was better than that in group B (P 0.05), and the swelling of affected limbs in group A was better than that in group B (P 0.05). There was no significant difference in VAS score at 6 h after operation (P 0.05), but the VAS score in group A was significantly lower than that in group B at 24 h, 48 h and 72 h after operation (P 0.05). On the 7th, 14th and 30th day after operation, the KSS score and knee motion in group A were better than those in group B (P 0.05), but there was no significant difference in KSS score between the two groups at 6 months, 12 months and 18 months after operation (P 0.05). Follow-up for 18 months showed no deep venous thrombosis and related complications in group A and group B. Conclusion: the multimode regimen has a significant effect on reducing blood loss after one knee TKA and even achieves the goal of zero blood transfusion rate, which can reduce the swelling of affected limbs in the early stage after TKA, relieve the early pain after operation, and improve the sleep quality of patients after operation. It also promotes the recovery of early KSS score and knee joint function in patients with TKA, and does not increase the occurrence of related complications. The multi-mode regimen is safe, effective, economical and simple.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4
【參考文獻】
相關(guān)期刊論文 前1條
1 彭輝煌;吳建偉;邱海勝;;全膝關(guān)節(jié)置換術(shù)后出血的影響因素及預(yù)防[J];國際骨科學雜志;2009年03期
，本文編號：2495557
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