不同麻醉方式对膝关节置换后下肢静脉血栓形成的影响:Meta分析（英文）

发布时间：2018-01-20 18:09

本文关键词： 关节成形术置换膝静脉血栓形成麻醉麻醉硬膜外植入物人工假体膝关节置换下肢静脉血栓形成全身麻醉硬膜外麻醉 Meta分析　出处：《中国组织工程研究》2015年35期 　论文类型：期刊论文

【摘要】：背景:虽然全膝关节置换治疗严重膝关节炎患者疗效可靠,但是,下肢静脉血栓形成仍会在很多患者中发生,因此下肢静脉血栓形成也成了目前接受全膝关节置换后突然死亡的最主要原因。目的:比较不同麻醉方式下进行全膝关节置换后下肢静脉血栓形成的差异。方法:利用"total knee arthroplasty","TKA","thrombosis","DVT","randomized controlled trial","RCT","全膝关节置换""血栓""麻醉"等关键词在"Pub Med","Medline","Elsevier","Embase","Cochrane library","万方","CNKI"等国内外主要数据库搜集了2000年1月到2015年3月期间发表的涉及到不同麻醉方式对膝关节置换后下肢深静脉血栓形成的影响方面的文献资料。通过双盲法进行数据提取,文献质量评估,并利用Revman5.3统计软件对所提取的数据进行了meta分析。结果与结论:最后总共有包含885例患者的8个文献被纳入此研究。通过分析发现在纳入的文献之间不存在显著异质性(I2=0,P=0.72)。数据合成后的OR是0.25(95%CI:0.18,1.35),说明利用连续硬膜外麻醉方式进行全膝关节置换能显著降低术后深静脉血栓形成的可能。因为缺乏全身麻醉与硬膜外麻醉下的患者凝血因子变化情况等数据,硬膜外麻醉降低深静脉血栓发生率的机制尚需进一步研究。说明在接受下肢静脉血栓的患者中,利用连续硬膜外麻醉可显著降低下肢静脉血栓的形成可能。因此在下肢静脉血栓形成高危患者中应该优先使用硬膜外麻醉方式进行膝关节置换。
[Abstract]:Background: although total knee arthroplasty is effective in the treatment of severe knee arthritis, venous thrombosis of lower extremity still occurs in many patients. Therefore, venous thrombosis of lower extremity has become the main cause of sudden death after total knee arthroplasty. Methods: using "total knee arthroplasty" to compare the differences of venous thrombosis in lower extremity after total knee arthroplasty under different anesthetic methods. "TKA", "thrombosis", "DVT", "randomized controlled trial", "RCT". The keywords of "total knee arthroplasty", "thrombus", "anesthesia" were "Pub Med", "Medline", "Elsevier", "Embase". "Cochrane library", "Wanfang". "CNKI" From January 2000 to March 2015, literature about the influence of different anesthetic methods on deep venous thrombosis of lower extremity after knee arthroplasty was collected. Double blind method for data extraction. Literature quality assessment. The extracted data are analyzed by meta using Revman5.3 software. Results and conclusions:. Finally, a total of 8 articles including 885 patients were included in the study. I20. The OR after data synthesis is 0.25 / 95 CI: 0.18 / 1.35). The results showed that total knee arthroplasty with continuous epidural anesthesia could significantly reduce the possibility of deep venous thrombosis after operation because of the lack of data on coagulation factors of patients under general anesthesia and epidural anesthesia. The mechanism of epidural anesthesia in reducing the incidence of deep venous thrombosis needs further study. The possibility of venous thrombosis in lower extremity can be significantly reduced by continuous epidural anesthesia. Therefore, epidural anesthesia should be given priority in knee arthroplasty in patients with high risk of lower extremity venous thrombosis.
【作者单位】：北京积水潭医院;清华大学医学中心;
【分类号】：R614
【正文快照】： INTRODUCTIONThe invention of total knee arthroplasty(TKA)is one of the most significant advancements inthe 20th century medicine.This technique haseffectively alleviated the pain of patients withlate-stage osteoarthritis,enhanced their abilityof mobility

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