静脉联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术后失血量的影响及安全性评价

发布时间：2018-01-30 10:46

本文关键词： 人工全膝关节置换术氨甲环酸术后引流失血量　出处：《中国修复重建外科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨静脉滴注联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术(total knee arthroplasty,TKA)术后失血量的影响并评价其安全性。方法于2015年9月—2016年7月拟行单侧初次TKA的102例患者中,选取80例符合选择标准的女性患者纳入研究。所有患者随机分为对照组(A组)、30 min组(B组)、60 min组(C组)和90 min组(D组),每组20例。4组患者年龄、体质量指数、患膝侧别、病因、病程以及术前血红蛋白、白蛋白、红细胞压积等一般资料比较,差异均无统计学意义(P0.05),具有可比性。所有患者均于松止血带前10 min静脉滴注氨甲环酸氯化钠100 m L(含1 g氨甲环酸)。关闭切口后,B、C、D组通过引流管向关节腔内注射相同浓度氨甲环酸氯化钠60 m L并夹闭引流管,A组同法注射60 m L生理盐水;A、B组于引流管夹闭后30 min、C组于60 min、D组于90 min后恢复引流。记录各组患者术后24 h引流量、总失血量,术后血红蛋白、白蛋白减少量,术后输血次数及输血量,以及下肢深静脉血栓形成、肺栓塞发生情况。结果 B、C、D组术后24 h引流量及总失血量均少于A组,其中C、D组与A组比较差异有统计学意义(P0.05),B组与A组比较差异无统计学意义(P0.05)。B组术后24 h引流量高于C、D组,且与D组比较差异有统计学意义(P0.05);C、D组间比较差异无统计学意义(P0.05)。B、C、D组总失血量组间比较差异无统计学意义(P0.05)。A~D组血红蛋白、白蛋白减少量呈逐渐降低趋势,但各组间差异无统计学意义(P0.05)。所有患者术后均无下肢深静脉血栓形成及肺栓塞发生。D组1例患者术后第3天白蛋白28 g/L,静脉输入人血白蛋白20 g;其余患者均未输血。结论静脉滴注联合关节腔内注射氨甲环酸可减少TKA围手术期失血量;关节腔内注射氨甲环酸后引流管夹闭60 min后再恢复引流止血效果最佳,并且不增加症状性下肢深静脉血栓形成和肺栓塞发生率。
[Abstract]:Objective to investigate the effect of intraarticular instillation of total knee arthroplasty on total total knee arthroplasty (TKA) after entrapment of drainage tube after intraarticular injection of aminocyclylic acid. Methods 102 patients with primary unilateral TKA were selected from September 2015 to July 2016. 80 female patients who met the selection criteria were selected. All the patients were randomly divided into control group (group A) and 30 min group (group B). Age, body mass index (BMI), knee side, etiology, course of disease, preoperative hemoglobin and albumin were 20 patients in each group (n = 20, n = 20) and 90 min group (n = 20, n = 20). There was no significant difference in hematocrit and other general data (P0.05). All patients were treated with 100 mL sodium methachloroate (100 mL) (containing 1 g methoxycycline) 10 min before the tourniquet. After closing the incision, all the patients were treated with BMC. In group D, 60 mL saline was injected into the articular cavity by drainage tube and 60 mL saline was injected into the same way by clipping the drainage tube. The drainage was recovered in group A (30 minutes after tube clipping) and in group D (60 minutes) after 90 min. The drainage was recorded 24 hours after operation and the total amount of blood loss was recorded. Hemoglobin, albumin, blood transfusion times, blood transfusion volume, deep vein thrombosis and pulmonary embolism occurred after operation. 24 hours after operation, the drainage volume and total blood loss in group D were lower than those in group A, and the difference between group C and group A was statistically significant (P 0.05). There was no significant difference between group B and group A (P 0.05). 24 hours after operation, the drainage volume in group B was higher than that in group C (D), and there was a significant difference between group B and group D (P 0.05). There was no significant difference in the total blood loss between the two groups. There was no significant difference in total blood loss between the two groups. The amount of albumin decreased gradually. However, there was no significant difference between the three groups (P 0.05). There was no postoperative deep venous thrombosis and pulmonary embolism in group D. one patient in group D had 28 g / L albumin on the 3rd day after operation. Human serum albumin (HSA) was injected intravenously at 20 g; Conclusion intravenous drip combined with intraarticular injection of carbamoic acid can reduce the perioperative blood loss of TKA. The best hemostatic effect was achieved after the drainage tube was clamped for 60 min and the incidence of symptomatic deep vein thrombosis and pulmonary embolism was not increased.
【作者单位】：四川大学华西医院骨科;
【分类号】：R687.4
【正文快照】： 人工全膝关节置换术(total knee arthroplasty,TKA)是治疗终末期膝关节疾病的有效方案,然而术中、术后出血是影响患者术后康复的主要问题之一。为了减少术中出血,保证术野清晰,临床多使用止血带。虽然止血带的应用减少了术中出血量,但限制了术中创面的有效彻底止血,导致止血带

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