氨甲环酸减少2型糖尿病患者全膝关节置换出血的安全性及有效性

发布时间：2018-01-24 10:00

本文关键词： 关节成形术置换膝失血手术氨甲环酸糖尿病组织工程骨科植入物人工假体全膝关节置换有效性安全性　出处：《中国组织工程研究》2017年11期 　论文类型：期刊论文

【摘要】：背景:全膝关节置换术创伤大,出血量多,多采用氨甲环酸减少出血。合并糖尿病的患者抗感染及组织愈合能力较差,加之可能存在的血管病变,氨甲环酸的应用是否会达到止血的目的且不增加下肢静脉血栓形成的风险,尚无相关文献报道。目的:探讨2型糖尿病患者全膝关节置换时应用氨甲环酸减少出血的安全及有效性。方法:选择2013年1月至2015年1月在贵州省骨科医院就诊并接受单侧全膝关节置换治疗的100例合并2型糖尿病的患者,2014年1月以前手术的46例患者为对照组,2014年1月以后手术的54例患者为试验组。试验组将15 mg/kg的氨甲环酸稀释于250 m L氯化钠溶液中在安置假体后松止血带前给予静脉点滴,对照组在相同时间给予250 m L氯化钠溶液静脉点滴。比较2组患者围手术期出血、输血情况、血红蛋白、红细胞比容以及凝血指标水平,并观察下肢深静脉血栓发生情况。结果与结论:(1)试验组术后引流量、总出血量、隐性失血量、术后输血量及术后输血率均小于对照组(P0.05);(2)术前2组患者血红蛋白质量浓度和红细胞比容差异无显著性意义;2组患者术后3 h,1 d和3 d的血红蛋白质量浓度及红细胞比容均较术前下降,术后5 d有所回升,但低于术前。试验组在术后相应时间点的血红蛋白质量浓度及红细胞比容均高于对照组(P0.05);(3)2组患者术前、松止血带时、术后3 h、术后1 d、术后5 d的凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原差异无显著性意义。术前、松止血带时2组患者的D-二聚体差异无显著性意义,术后3 h,1 d及后5 d 2组患者的D-二聚体水平均较术前升高,且试验组术后3 h及1 d时小于对照组,差异有显著性意义(P0.05),术后5 d时2组D-二聚体水平差异无显著性意义;(4)术后5 d及术后1个月时2组患者双下肢静脉彩超未见明显下肢深静脉血栓形成;(5)结果提示,2型糖尿病患者全膝关节置换术中在松止血带前按15 mg/kg静脉应用氨甲环酸以减少出血是安全、有效的。
[Abstract]:Background: total knee arthroplasty has the advantages of large trauma, large amount of blood loss, and the use of carbamoic acid to reduce bleeding. Patients with diabetes mellitus have poor ability of anti-infection and tissue healing, together with possible vascular diseases. Whether the use of carbamoic acid can achieve the purpose of hemostasis and does not increase the risk of venous thrombosis in the lower extremity. Objective: to investigate the safety and efficacy of the application of carbamoic acid in reducing bleeding in patients with type 2 diabetes mellitus after total knee arthroplasty. From January 2013 to January 2015, 100 patients with type 2 diabetes mellitus were treated with unilateral total knee arthroplasty at Guizhou Orthopaedic Hospital. Before January 2014, 46 patients were treated as control group. After January 2014, 54 patients underwent operation in the trial group. The experimental group diluted 15 mg/kg of carbamoic acid to 250m. L sodium chloride solution was given intravenously before the release of the tourniquet after the prosthesis was placed. The control group was given 250 mL sodium chloride solution intravenously at the same time. The perioperative bleeding, blood transfusion, hemoglobin, erythrocyte volume and coagulation index were compared between the two groups. Results and conclusion the postoperative drainage volume, total blood loss, recessive blood loss, postoperative blood transfusion volume and postoperative blood transfusion rate in the test group were lower than those in the control group (P 0.05). (2) there was no significant difference in hemoglobin concentration and erythrocyte volume between the two groups before operation. The hemoglobin concentration and erythrocyte specific volume of the two groups were decreased at 1 and 3 days after operation, and increased at 5 days after operation. The hemoglobin concentration and erythrocyte specific volume in the test group were higher than those in the control group at the corresponding time after operation (P 0.05). There was no significant difference in prothrombin time, activated partial thromboplastin time and fibrinogen between the two groups. There was no significant difference in D-dimer between the two groups at the time of loosening tourniquet. The level of D-dimer in group 2 was higher than that before operation 3 hours after operation and 5 days after operation. At 3 h and 1 d after operation, there was a significant difference in the levels of D- dimer between the two groups (P 0.05), and there was no significant difference in the level of D- dimer between the two groups at 5 days after operation. 4) on the 5th day after operation and 1 month after operation, there was no obvious deep vein thrombosis in both groups. 5) the results suggest that it is safe and effective for patients with type 2 diabetes to reduce bleeding by intravenous injection of carbonic acid 15 mg/kg before loosening tourniquet during total knee arthroplasty.
【作者单位】：贵州省骨科医院骨外科;
【分类号】：R587.1;R687.4
【正文快照】： 文章快速阅读:2型糖尿病患者全膝关节置换术中在松止血带前应用氨甲环酸安全有效观察指标:结论:试验组54例:比较2型糖尿病患者将15 mg/kg的氨甲环酸2组患者术后引流量、总出血量、隐全膝关节置换术稀释于250 mL氯化钠溶性失血量、术后输血中在松止血带前液中在安置假体后松止

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