关节内注射氨甲环酸联合引流管夹闭3小时方案减少初次单膝关节置换术患者围术期失血的有效性及安全性研究

发布时间：2018-06-09 06:58

本文选题：关节成形术 + 置换　；参考：《中国全科医学》2015年06期

【摘要】：目的探讨采用关节内注射氨甲环酸联合引流管夹闭3 h方案减少初次单膝关节置换术患者围术期失血量的有效性和安全性。方法选取2013年12月—2014年2月安徽医科大学附属省立医院骨科行单侧首次全膝关节置换术的老年患者90例(90膝),采用随机数字表法将患者分为试验组与对照组,每组45例。患者均完善术前常规检查,同时行双下肢静脉彩超,试验组于手术关闭筋膜层后关节内注射氨甲环酸并夹闭引流管3 h,对照组关节内注射20 ml 0.9%氯化钠溶液并维持引流管开放,两组患者引流管均于术后48 h拔除。记录术前两组患者年龄、性别、左/右侧、体质指数、手术时间、美国麻醉师协会(ASA)评分、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平,术前及术后1、3 d血红蛋白及血细胞比容(HCT),总失血量、术后引流量、隐性失血量、输血量。结果两组患者年龄、性别、左/右侧、体质指数、手术时间、ASA评分、PT、APTT、FIB水平比较,差异均无统计学意义(P0.05)。两组患者术前及术后1、3 d血红蛋白及HCT比较,差异均有统计学意义(P0.05);治疗方法与治疗时间存在交互作用(P0.05)。试验组患者术后总失血量、术后引流量、隐性失血量、输血量较对照组均减少(P0.05)。两组患者的手术切口均一期愈合,且均未出现严重并发症和不良反应,术后第7天复查双下肢静脉彩超均未发现静脉血栓。结论关节内注射氨甲环酸联合引流管夹闭3 h方案可有效减少初次单膝关节置换术后的血液丢失,同时不增加下肢深静脉血栓等发生率,该方案有效、安全。
[Abstract]:Objective to investigate the efficacy and safety of intraarticular injection of methacylic acid combined with drainage tube clamping for 3 h in the reduction of perioperative blood loss in patients undergoing primary single knee arthroplasty. Methods from December 2013 to February 2014, 90 elderly patients undergoing unilateral total knee arthroplasty in Department of Orthopaedics, affiliated Hospital of Anhui Medical University, were randomly divided into experimental group (n = 45) and control group (n = 45). All the patients were performed routine examination before operation, and both lower extremity venous ultrasound was performed. The experimental group was treated with intraarticular injection of aminocyclylic acid and clamping drainage tube for 3 h after the fascial layer was closed, while the control group was treated with 20 ml 0.9% sodium chloride solution intraarticularly and the drainage tube was kept open. The drainage tubes were removed 48 hours after operation in both groups. Age, sex, left / right side, body mass index, operation time, ASAs score, prothrombin time (PTT), activated partial thromboplastin time (APTTT), fibrinogen FIBs (FIBs) were recorded. Before and 1 day after operation, hemoglobin and HCT volume, total blood loss, postoperative drainage, recessive blood loss and blood transfusion volume were measured. Results there was no significant difference in age, sex, left / right side, body mass index, ASA score and PTT TTT FIB between the two groups (P 0.05). There were significant differences in hemoglobin and HCT between the two groups before and 1 day after operation, there was significant difference between the two groups (P 0.05), and there was interaction between the treatment method and the treatment time (P 0.05). Compared with the control group, the total blood loss, postoperative drainage, recessive blood loss and blood transfusion volume of the patients in the trial group were lower than those in the control group (P 0.05). The incisions of both groups were healed at the first stage, and no serious complications or adverse reactions were found. On the 7th day after operation, no venous thrombosis was found in both lower extremity venous color Doppler ultrasound. Conclusion Intra-articular injection of carbamoic acid combined with tube clipping for 3 hours can effectively reduce the blood loss after the first single knee arthroplasty without increasing the incidence of deep venous thrombosis of lower extremity. It is effective and safe.
【作者单位】：安徽医科大学附属省立医院骨2科;
【分类号】：R687.4

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