不同引流方式对单侧人工全膝关节置换术后隐性失血及术后功能康复影响的随机对照研究

发布时间：2018-03-06 19:01

本文选题：膝骨性关节炎　切入点：全膝关节置换术　出处：《泰山医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的比较单侧人工全膝关节置换术后放置闭式引流(不夹闭，夹闭4小时、6小时)与不放置闭式引流对隐性失血的差异以及对术后康复功能锻炼的影响，分析讨论术后放置引流后的不同处理方式对隐性失血及康复锻炼的影响，从而选择最佳措施，指导临床工作。方法对我院2011年9月～2013年2月112例行单侧人工全膝关节置换术的患者随机分为放置闭式引流（不夹闭组，夹闭4h组、6h组）与不放置闭式引流组4组，进行前瞻性研究，所有患者均由同一组医师完成手术，既往无膝关节手术史，均为初次行膝关节置换术，均使用连续硬膜外麻醉，采用相同术式操作，术中术后血压平稳。根据身高，体重，手术前后的红细胞压积(Hct)以及输血量，通过Gross方程推算术后总失血量，分别比较四组患者术后48h引流量，计算出隐性失血量，且对患者术后2天、7天、2周的VAS疼痛评分测定及12月后膝关节功能（HSS评分）情况进行评价。使用统计学软件SPSS19.0进行统计学分析，用均数±标准差(x±s)来表示所有测得的计量资料，采用one-wayANOVA方差分析对多个样本之间的数据进行比较，组间两两比较采用t检验。计数资料采用行x列表资料的卡方检验，P0.05为无统计学差异。结果四组间的一般临床资料在统计学上差异无显著性意义。单侧人工全膝关节置换术后使用闭式引流组总失血量明显多于未使用闭式引流组，且有统计学意义(P=0.05)；早期夹闭组(4h组和6h组)的总引流量均显著低于未夹闭组，且有统计学意义(P0.01)；夹闭6h组隐性失血量较未放置引流组、未夹闭组少，且有统计学意义（P0.01）；夹闭4h组与夹闭6h组在隐性失血量上无差异(P0.05)；不放置引流组与放置引流组比较，VAS评分在术后2d、7d及2周明显增高，差异有统计学意义(P0.01)；放置引流组中，未夹闭组与夹闭4h、6h组相比在术后2d和7d的VAS评分明显减少，差异具有统计学意义(P0.01)，，夹闭4h与6h组间VAS疼痛评分无明显差异(P0.05)。至术后2周，放置引流3组间的VAS评分无统计学差异(P0.05)。术后相关合并症及术后12月后HSS评分方面四组间差异无显著性意义(P0.05)。结论引流管早期夹闭能够明显减少全膝关节置换术后的失血量，且不增加相关的术后并发症，早期功能康复的整体效果明显，术后患者的疼痛较未放置闭式引流者明显减轻，其中夹闭6h组隐性失血量及总失血量较未夹闭组和夹闭4h组少，是一个比较好的时间选择。故TKA术后常规夹管6h方法简单，临床效果良好，具有一定的使用价值。
[Abstract]:Purpose. To compare the difference between closed drainage (no clamping, clamping for 4 hours and 6 hours) and closed drainage after unilateral total knee arthroplasty on recessive blood loss and the effect on rehabilitation function training after operation. To analyze and discuss the influence of different ways of treatment after drainage on recessive blood loss and rehabilitation exercise, so as to select the best measures to guide the clinical work. Method. Patients undergoing unilateral total knee arthroplasty from September 2011 to February 2013 in our hospital were randomly divided into 4 groups: closed drainage group (no clamping group, clamping 4 h group, 6 h group) and no closed drainage group (4 h group). All the patients were operated by the same group of doctors. They had no history of knee joint surgery. All patients underwent knee arthroplasty for the first time. All patients were treated with continuous epidural anesthesia with the same operation. The blood pressure was stable after operation, according to height and weight, The hematocrit before and after operation and the amount of blood transfusions were calculated by Gross equation. The total blood loss was estimated by Gross equation, and the recessive blood loss was calculated by comparing the drainage volume at 48 hours after operation in the four groups. The VAS pain score and the knee function score after December were evaluated. The statistical software SPSS19.0 was used for statistical analysis, and the mean 卤standard deviation (x 卤s) was used to represent all the measured data. One-wayANOVA analysis of variance was used to compare the data among multiple samples, and t test was used to compare the data between groups. The counting data were analyzed by chi-square test (P05) with x list data. No statistical difference was found between the two groups. Results. There was no statistically significant difference in the general clinical data among the four groups. The total blood loss in the closed drainage group was significantly higher than that in the non-closed drainage group after unilateral total knee arthroplasty. The total drainage volume in the early clipping group was significantly lower than that in the unclamped group (4 h and 6 h group), and there was significant difference between the two groups (P 0.01), and the recessive blood loss in the 6 h clipping group was less than that in the no drainage group. There was no significant difference in the amount of recessive blood loss between the group of 4 h and the group of 6 h. The score of VAS in the group without drainage was significantly higher than that in the group without drainage at 2 days and 2 weeks after operation, and the difference was statistically significant (P 0.01), and that in the group without drainage was significantly higher than that in the group without drainage (P 0.01), and there was no significant difference in the amount of recessive blood loss between the groups of 4 h and 6 h. The VAS scores in the non-clipping group were significantly lower than those in the 4-hour and 6h group, and the difference was statistically significant (P 0.01). There was no significant difference in the VAS pain score between the 4 h and 6 h clipping groups (P 0.05) from 2 weeks to 2 weeks after operation. There was no significant difference in VAS scores among the three groups (P 0.05). There was no significant difference in the HSS scores between the four groups in postoperative complications and December. Conclusion. The early clamping of drainage tube can significantly reduce the amount of blood loss after total knee arthroplasty, and does not increase the postoperative complications. The overall effect of early functional rehabilitation is obvious. The pain of postoperative patients is significantly reduced than that of patients without closed drainage. The recessive blood loss and total blood loss in the 6 h clipping group were less than those in the unclipped group and the clipping 4 h group, which was a better choice of time. Therefore, the routine 6 h clamp method after TKA operation was simple, the clinical effect was good, and it had certain practical value.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4

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