氨甲环酸减少双侧全膝关节置换术围手术期出血的有效性及安全性观察

发布时间：2018-06-03 21:49

本文选题：氨甲环酸 + 人工全膝关节置换术　；参考：《山东医药》2015年36期

【摘要】：目的探讨氨甲环酸减少同期双侧人工全膝关节置换术围手术期出血的有效性和安全性。方法选择2012年5月~2015年1月同期行双侧人工全膝置换术患者83例,2013年7月以前手术患者45例为对照组,2013年7月以后手术患者38例为观察组。两组均采用全身或椎管麻醉、于止血带下完成手术。观察组上止血带前静滴氨甲环酸1 g(10 m L),手术结束后关节腔内注射氨甲环酸4 g;对照组未使用氨甲环酸。记录两组术后引流量、总失血量、隐性出血量、输血率、输血量、血红蛋白水平、血小板计数以及症状性静脉栓塞发生情况。结果观察组与对照组术后总引流量分别为(177.8±166.7)和(509.9±326.4)m L,总失血量分别为(678.1±366.1)和(1 581.9±563.0)m L,隐性失血量分别为(500.3±298.6)和(1 089.0±578.0)m L,总输血量分别为(1.4±1.9)和(5.5±2.9)U,输血率分别为44.7%(17/38)和97.8%(44/45),两组比较P均0.01;观察组与对照组术后第5天血红蛋白水平分别为(100.8±112.4)和(95.1±10.5)g/d L,两组比较P0.01;观察组与对照组术后血小板计数、发生症状性静脉血栓情况比较均无统计学差异(P均0.05)。结论静滴结合关节内注射氨甲环酸可减少同期双侧人工全膝关节置换术术后出血量,且不增加血栓发生风险。
[Abstract]:Objective to evaluate the efficacy and safety of methacylic acid in reducing perioperative bleeding in bilateral total knee arthroplasty. Methods Eighty-three patients underwent bilateral total knee arthroplasty from May 2012 to January 2015, 45 patients before July 2013 as control group and 38 patients as observation group after July 2013. Both groups were anesthetized by whole body or spinal canal and operated under tourniquet. In the observation group, 1 g / 10 mg / L of methocylic acid was injected intraarticularly before tourniquet in the observation group, and 4 g / kg was injected into the articular cavity of the control group, while the control group was not treated with the methoxycycline. Postoperative drainage, total blood loss, recessive blood loss, blood transfusion rate, blood transfusion volume, hemoglobin level, platelet count and the occurrence of symptomatic venous embolism were recorded in both groups. Results the total drainage volume was 177.8 卤166.7 and 509.9 卤326.4mL, the total blood loss was 678.1 卤366.1) and 1 581.9 卤563.0 mL, respectively, the recessive blood loss was 500.3 卤298.6) and 1 089.0 卤578.0 mL, the total blood transfusion volume was 1.4 卤1.9) and 5.5 卤2.9 U respectively, the rates of blood loss were 44.77.17% and 97.884% -444.45%, respectively. The hemoglobin levels in the observation group and the control group were 100.8 卤112.4 and 95.1 卤10.5)g/d / L on the 5th day after operation, respectively, compared with that in the control group (P 0.01), and the platelet count in the observation group and the control group was higher than that in the control group (P < 0.05). There was no statistical difference in the occurrence of symptomatic venous thrombosis (P < 0.05). Conclusion intravenous drip combined with intraarticular injection of aminocyclylic acid can reduce the amount of blood loss after bilateral total knee arthroplasty and does not increase the risk of thrombosis.
【作者单位】：北京积水潭医院;
【基金】：国家自然科学基金资助项目(81472139)
【分类号】：R687.4

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