人工关节置换术术中使用碘伏冲洗术区对甲状腺功能的影响

发布时间：2018-05-17 02:30

本文选题：碘伏 + 游离三碘甲状腺原氨酸　；参考：《吉林大学》2015年硕士论文

【摘要】：背景：人工关节置换术的主要作用是缓解关节病变带来的疼痛和改善关节活动度，低于10%的患者在术后会出现与假体相关的并发症，其主要原因是假体周围无菌环境的破坏。假体周围感染（prosthetic jointinfection，PJI）是人工关节置换术后最严重的并发症之一，患者除了需要面临长期住院治疗，承担多次手术和抗生素治疗带来的额外经济负担，还需要承担关节失去功能甚至致残的风险。据统计，初次人工膝关节置换（total knee arthroplasty，TKA）术后PJI发生率为1.21%，初次人工髋关节置换（total hip arthroplasty,THA）术后PJI发生率为1.07-1.40%。随着科学技术的进步及医疗卫生水平的提高，人工关节置换术后PJI的发生率下降至0.7%。虽然整体术后PJI发生率有所下降，但随着人工关节置换患者数量的增加，PJI实际患者数量未见明显下降，甚至有上升的趋势。对于初次行人工关节置换术的无感染的患者，术区无菌状态的保持对术后PJI的预防显得尤为重要。聚维酮碘（Povidone iodine，PVP-I），又称碘伏，由于其具有广谱的强力的杀菌作用，对细菌、病毒、真菌及寄生虫等均有很强的杀灭作用，且具有不易使微生物产生耐药，对皮肤黏膜几乎无刺激，不易发生过敏反应，作用持久，稳定性好，易清洗等优点，故在临床上得到广泛应用。考虑其对微生物的杀灭作用持久，且对组织无毒、低刺激性等优点，本研究将其用于人工关节置换术术中冲洗。有实验表明，使用碘伏作为术中冲洗液，不仅可以高效杀灭污染菌，降低切口感染率，还促进局部组织脱水，使创面干燥，改善血液循环，从而利于切口愈合。有报道显示，对烧伤患者使用碘伏冲洗，可导致患者体内碘紊乱，表现为甲状腺功能的紊乱。长期使用碘伏洗手及漱口及长期接触碘伏的医护人员，存在出现甲状腺功能紊乱及增加甲状腺疾病发病率的风险。使用碘伏灌洗治疗化脓性关节炎，对甲状腺功能有影响，治疗超过1周的患者，甲状腺功能改变更为明显。但目前未见使用碘伏进行术区冲洗，对甲状腺功能的影响的报道。本文就人工关节置换术术中使用碘伏冲洗，对患者甲状腺功能产生的影响进行研究。目的：本研究通过对比行人工关节置换术患者，术前和术后第一天游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)的变化，探讨术中使用碘伏冲洗术区对甲状腺功能的影响。方法：将60名初次行人工关节置换术的患者随机分为两组，实验组和对照组，每组30人。实验组患者于术中使用碘伏冲洗术区，对照组患者于术中使用生理盐水冲洗术区。分别于入院时和术后第1天，抽取所有患者静脉血，检测FT3、FT4、TSH。结果：实验组与对照组间甲状腺功能变化的差异无统计学意义。（p＞0.05）研究中所有患者，术后FT3、FT4、TSH均较术前有所下降，且术前与术后FT3、FT4、TSH的变化有统计学意义（p＜0.05）。结论：人工关节置换手术术中使用碘伏冲洗术区，不足以影响患者甲状腺功能的变化。临床可以使用碘伏冲洗术区，预防术后感染。手术或麻醉等应激均可导致甲状腺功能变化，当应激消失后，无甲状腺相关疾病的患者，均可在短期内代偿，不足以引起机体代谢异常。
[Abstract]:Background: the main role of artificial joint replacement is to relieve the pain caused by joint lesions and to improve the degree of joint activity. Less than 10% of patients have complications associated with the prosthesis after operation, mainly due to the destruction of the aseptic environment around the prosthesis. Periprosthetic infection (prosthetic jointinfection, PJI) is the postoperative prosthetic replacement. One of the most serious complications, in addition to the need for long-term hospitalization, takes on the additional economic burden of multiple operations and antibiotic treatment, and the risk of joint loss of function and even disability. According to statistics, the incidence of PJI after primary artificial knee replacement (total knee arthroplasty, TKA) is 1.21%, the first artificial hip The incidence of PJI after total hip arthroplasty (THA) was 1.07-1.40%. with the progress of science and technology and the improvement of medical and health level. The incidence of PJI decreased to 0.7%. after arthroplasty, although the incidence of PJI decreased after total operation, but the number of patients with artificial arthroplasty increased, and the number of PJI patients was not. The preservation of the aseptic state of the surgical area is particularly important for the prevention of postoperative PJI. Polyvidone iodine (Povidone iodine, PVP-I), also known as iodophor, has a wide spectrum of bactericidal effect on bacteria, viruses, fungi and parasites. It has a strong killing effect, and it is not easy to produce resistance to microorganism, almost no irritation to the skin and mucous membrane, not easy to take place anaphylaxis, protracted effect, good stability, easy to clean and so on, so it is widely used in clinical. It is used in the operation of artificial joint replacement. It has been shown that the use of iodophor can not only effectively kill the contaminated bacteria, reduce the infection rate of the incision, but also promote the dehydration of the local tissue, make the wound dry, improve the blood circulation and improve the healing of the incision. It is reported that the use of Iodophor for burn patients can cause the disease. Patients with iodine disorders in the body, manifested as thyroid dysfunction. Long-term use of iodophor washing hands and mouthwash and long-term contact with Iodophor has the risk of thyroid dysfunction and increasing the incidence of thyroid diseases. The changes in the function of the glands are more obvious. However, there is no report of the effect of iodophor irrigation on the thyroid function. The effect of iodophor irrigation on the thyroid function in patients with artificial joint replacement is studied in this paper.
Objective: To investigate the effects of iodophor thyroxine (FT3), free thyroxine (FT4) and thyrotropin (TSH) on the thyroid function in patients undergoing intraoperative intraoperative intraoperative arthroplasty. The effect of iodophor irrigation area on thyroid function was discussed.
Methods: 60 patients with artificial joint replacement were randomly divided into two groups, the experimental group and the control group, with 30 people in each group. The patients in the experimental group were treated with Iodophor irrigation area, and the control group was treated with saline irrigation area during the operation. The venous blood was extracted from all patients at admission and first days after the operation, and FT3, FT4, TSH. were detected.
Results: there was no significant difference in the changes of thyroid function between the experimental group and the control group. (P > 0.05) all the patients in the study were decreased in FT3, FT4, TSH after operation, and the changes of FT3, FT4 and TSH before and after operation were statistically significant (P < 0.05).
Conclusion: the use of iodophor irrigation area in artificial joint replacement is not enough to affect the change of thyroid function. The iodophor irrigation area can be used to prevent postoperative infection. Surgery or anesthesia can lead to the change of thyroid function. After the stress disappears, patients with no thyroid related diseases can be replaced in a short time. Compensation is not enough to cause abnormal metabolism of the body.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.42

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