全膝关节置换后静脉与局部应用氨甲环酸对失血量的影响

发布时间：2018-07-05 07:42

本文选题：关节成形术 + 置换　；参考：《中国组织工程研究》2015年35期

【摘要】：背景:目前关于全膝关节置换过程中使用氨甲环酸减少出血的报道越来越多,但对于使用方式的选择仍存在争议。目的:通过术中关节腔周围组织局部注射和静脉注射两种不同的给药途径,探讨氨甲环酸对初次单侧全膝关节置换后失血量的影响。方法:根据随机对照原则设计,选取滕州市中心人民医院2013年10月至2014年12月收治拟行单侧全膝关节置换的患者90例,随机分为静脉组和局部组(n=45)。静脉组患者在全身麻醉诱导期接受静脉输注氨甲环酸(10 mg/kg最大剂量1.2 g);局部组于假体安装结束后,缝合关节囊前,在关节周围软组织注射氨甲环酸(2 g溶于50 m L生理盐水)。比较两组患者置换后引流量、置换后次日血红蛋白及红细胞压积、输血例数,同时观察是否有肺栓塞及下肢深静脉栓塞的临床症状出现,必要时行下肢血管多普勒超声检查。结果与结论:置换后引流量、置换后次日血红蛋白值及红细胞压积、输血人数及输血比率比较,两组差异无显著性意义(P0.05)。两组患者置换后14 d均未发现下肢深静脉血栓形成。提示与静脉全身应用相比,全膝关节置换过程中关节周围局部应用氨甲环酸同样能达到有效减少置换后失血和输血的效果,并可避免静脉应用氨甲环酸可能带来的相关并发症。
[Abstract]:Background: there are more and more reports on the use of carbamate to reduce bleeding during total knee arthroplasty, but the choice of use mode is still controversial. Objective: to investigate the effect of carbamoic acid on blood loss after primary total knee arthroplasty by intraoperative injection of intraarticular periarticular tissue and intravenous injection. Methods: according to the principle of randomized control, 90 patients with unilateral total knee arthroplasty were selected from Tengzhou Central people's Hospital from October 2013 to December 2014. They were randomly divided into intravenous group and local group (n = 45). Patients in the intravenous group received intravenous infusion of methocylic acid (10 mg/kg, maximum dose 1.2 g);) during the period of general anesthesia induction. After the prosthesis was installed, the patients in the venous group were injected with the periarticular soft tissue before the closure of the joint capsule (2 g dissolved in 50 mL normal saline). The drainage flow, hemoglobin, hematocrit and blood transfusion were compared between the two groups after replacement. The clinical symptoms of pulmonary embolism and deep vein embolism of lower extremity were observed at the same time. Doppler ultrasound of lower extremities was performed when necessary. Results and conclusion: there was no significant difference in drainage volume, hemoglobin value, hematocrit, number of blood transfusion and blood transfusion ratio between the two groups (P0.05). Deep venous thrombosis of lower extremity was not found in both groups on the 14th day after replacement. The results suggest that local application of carbamoic acid during total knee arthroplasty can also reduce blood loss and blood transfusion effectively and avoid complications caused by intravenous application of carbamoic acid in total knee arthroplasty.
【作者单位】：滕州市中心人民医院关节运动医学二科;解放军济南军区总医院脊髓修复科;
【分类号】：R687.4

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