氨甲环酸注射液对全膝关节置换围手术期失血量影响的探讨

发布时间：2018-10-08 07:26

【摘要】：目的探讨氨甲环酸注射液对全膝关节置换围手术期失血量的影响。方法选取2015年3月-2016年8月于该院收治的147例初次实施单侧全膝关节置换的类风湿关节炎或骨性关节炎患者,按照随机数字表法将所有患者随机分为单次使用组和重复使用组以及对照组3组,每组患者49例,所有患者均在术前半小时和间隔12 h后使用头孢呋辛1.5 g以预防出现感染,对于对头孢呋辛过敏的患者则在术前2 h给予克林霉素治疗。所有患者手术均在止血带下完成,麻醉方式均为神经阻滞联合全身麻醉的方式,在手术完成时缝合伤口并运用弹力绷带加压包扎。单次使用组患者在术前半小时给予10 mg/kg的氨甲环酸进行静脉滴注,而重复使用组则分别在术前半小时给予10 mg/kg的氨甲环酸进行静脉滴注,安装好假体后在患者假体周围再次注射50 ml氨甲环酸注射液,而对照组患者则在手术前后不再使用氨甲环酸注射液。患者住院期间应选择低分子肝素进行药物预防,出院后则口服10 mg的利伐沙班至术后2周左右,每天服用1次。分析比较3组患者的隐形失血量和总失血量以及术中失血量、引流量、输血患者比例、肺栓塞和深静脉血栓的发生等指标。结果重复使用组患者的术后引流量、术中失血量、隐形失血量和术后总失血量等均低于单次使用组患者,而单次使用组患者的术后引流量、术中失血量、隐形失血量和术后总失血量等则低于对照组患者(P0.05);单次使用组和重复使用组患者的输血患者比例均低于对照组(χ~2=3.984和5.482,P0.05),而单次使用组的输血患者比例则高于重复使用组(χ~2=8.182,P0.05)。各组患者术后均无肺栓塞和深静脉血栓等并发症出现,单次使用组有4例患者出现肌间静脉血栓,而重复使用组和对照组则各有3例患者出现肌间静脉血栓,各组患者并发症发生率差异无统计学意义(χ~2=0.173,P0.05)。结论氨甲环酸注射液能够在不增加肺栓塞和深静脉血栓发生率的同时,有效降低全膝关节置换术中患者的出血量,减少患者的输血比例和输血量,值得在临床上加以推广使用。
[Abstract]:Objective to investigate the effect of carbonic acid injection on blood loss in perioperative period of total knee arthroplasty. Methods from March 2015 to August 2016, 147 patients with rheumatoid arthritis (RA) or osteoarthritis (OA) undergoing unilateral total knee arthroplasty (TKR) were selected. All patients were randomly divided into single use group, repeated use group and control group. 49 patients in each group were treated with cefuroxime 1.5 g before operation and 12 hours after operation to prevent infection. Patients with cefuroxime allergy were treated with clindamycin 2 hours before operation. All the patients underwent the operation under tourniquet. The anesthesia was nerve block combined with general anesthesia. The wound was sutured at the end of the operation and the elastic bandage was applied to compress the wound. Patients in the single use group were given 10 mg/kg of methionine intravenously at half an hour before operation, while those in the repeated use group were given 10 mg/kg of methacylic acid half an hour before operation. After the prosthesis was installed, 50 ml carbamate injection was injected around the prosthesis of the patients, while the control group did not use the carbamate injection before and after operation. Patients should choose low-molecular-weight heparin for drug prevention during hospitalization. After discharge, they should take Lipashaban for 10 mg and take it once a day for about 2 weeks after operation. The invisible blood loss, total blood loss, intraoperative blood loss, drainage volume, the proportion of blood transfusion patients, pulmonary embolism and deep vein thrombosis were analyzed and compared among the three groups. Results the postoperative drainage volume, intraoperative blood loss, invisible blood loss and total postoperative blood loss in the repeated use group were lower than those in the single use group, while the postoperative drainage volume and the intraoperative blood loss in the single use group were lower than those in the single use group. The volume of invisible blood loss and total blood loss after operation were lower than those of the control group (P0.05), while the proportion of patients with single use and repeated use was lower than that of the control group (蠂 2 + 3.984 and 5.482P 0.05), while the proportion of single use group was higher than that of repeated use group (蠂 2 + 8.182 P 0.05). There were no complications such as pulmonary embolism and deep vein thrombosis in all the groups. Four patients in the single use group had intermuscular venous thrombosis, while 3 patients in the repeated use group and 3 patients in the control group had intermuscular venous thrombosis. There was no significant difference in the incidence of complications among the three groups (蠂 2 / 0.173 P 0.05). ConclusionMethacylic acid injection can effectively reduce the amount of blood loss in patients undergoing total knee arthroplasty without increasing the incidence of pulmonary embolism and deep vein thrombosis, and reduce the proportion and quantity of blood transfusion in patients with total knee arthroplasty, so it is worth popularizing in clinic.
【作者单位】：贵州省骨科医院;
【分类号】：R687.4

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