灌注氨甲环酸联合术后引流对膝关节置换术后失血问题的分析研究

发布时间：2018-03-08 17:30

本文选题：膝关节表面置换　切入点：氨甲环酸　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探索分析膝关节表面置换术后关节腔灌注氨甲环酸联合术后间断引流对术后失血的效果,探索一种有效减少膝关节表面置换术后失血的有效方法。方法:筛选自2015年12月至2016年10月在泰山医学院附属莱芜医院骨科行膝关节表面置换的60岁以上患者作为研究对象,其中男41例,女49例,年龄61~84岁,平均70.4岁,骨性关节炎患者75例,类风湿患者15例,排除相关内科疾病,改组患者手术由同一组医师在止血带下完成,均进行膝关节表面置换,假体统一使用台湾联合公司提供后稳定型关节,关闭切口前引流管常规剪侧孔放置于关节腔内,缝合伤口后均进行加压包扎,术后根据引流管注入药物和术后引流方式将本组患者随机分为三组,A组经引流管灌注0.9%的生理盐水30ml后夹闭引流管,夹闭2小时放开10分钟再次夹闭引流管,反复夹管5次行间断引流;B组将0.5g氨甲环酸注射液溶于20ml0.9%的生理盐水中,经引流管灌注于关节内,夹管2小时后放开行延迟开放引流;C组将0.5g氨甲环酸注射液溶于20ml0.9%的生理盐水中,经引流管灌注于关节内,术后行间断引流。分别记录(1)三组患者术后引流袋引流量。(2)所有患者术前及术后48小时常规行血常规检查,并记录血红蛋白值(3)分别记录所有患者术前及术后48小时拔除引流管时测量髌上10cm处髌上周径(4)术后输血患者常规记录,计算输血率(5)术后2周刀口愈合率,根据术后刀口愈合情况如实记录(6)记录术后2周膝关节活动情况。使用SPSS 16.0软件分析所测数据,以确定P值,确定差距是否具有临床意义。结果:本组90例患者获得完整随访资料,手术时间(55-140min),住院天数(14-20天),90患者中7例刀口浅表感染,通过换药刀口愈合,刀口愈合率均为100%,C组和B组有3例患者输血,A组14例患者。在髌上周径变化值、关节活动度无统计学意义,术后引流袋引流量和HB变化值C组最优,其次B组,A组最差。结论:膝关节表面置换术后灌注氨甲环酸生理盐水联合间断引流能有效减少TKA患者术后失血。
[Abstract]:Objective: to explore the effect of intraarticular instillation of carbamoic acid combined with postoperative intermittent drainage on postoperative blood loss after surface replacement of knee joint. Objective: to explore an effective method to reduce blood loss after knee joint surface replacement. Methods: from December 2015 to October 2016, patients over 60 years old who underwent knee joint surface replacement in Department of Orthopaedics, Laiwu Hospital affiliated to Taishan Medical College were selected as study subjects. Among them, 41 males and 49 females, aged 61 to 84 years (mean 70.4 years), 75 patients with osteoarthritis and 15 patients with rheumatoid diseases were excluded from related internal diseases, and the operation was performed by the same group of doctors under tourniquet. All of them underwent knee joint surface replacement, the prosthesis was unified with the post-stable joint provided by the Taiwan Union Company, and the normal shearing hole of the anterior drainage tube was placed in the joint cavity after closing the incision. After the wound was sutured, the joint was bound under pressure. The patients were randomly divided into three groups according to the drug injection and drainage method after operation. Group A was infused with 0.9% normal saline (30 ml) through the drainage tube and then clipped the drainage tube. The drainage tube was closed again for 10 minutes after clipping for 2 hours. In group B, 0.5 g carbonic acid injection was dissolved in 20 ml 0.9% of normal saline and perfused into joints through drainage tube. In group C, 0.5 g carbamoic acid injection was dissolved in 20 ml 0.9% of normal saline and perfused into the joint through a drainage tube. Discontinuous drainage was performed after operation. 1) drainage bag drainage volume. 2) routine blood routine examination was performed before and 48 hours after operation in all patients. The hemoglobin values were recorded and the routine records of blood transfusion patients were recorded before operation and 48 hours after operation when the drainage tube was removed. The blood transfusion rate was calculated at 5) and the wound healing rate was calculated 2 weeks after operation. The knee joint movement was recorded 2 weeks after operation according to the healing of the knife edge. The data were analyzed by SPSS 16.0 software to determine the P value. Results: 90 patients received complete follow-up data, the operation time was 55-140 mins, the hospitalization time was 14 to 20 days, the superficial infection of knife edge was found in 7 cases, and the wound healed by dressing change. There were 3 patients in group A and 14 patients in group A. There was no statistical significance in the change of patellar diameter and motion of joint. The drainage bag drainage volume and HB change value were the best in group C. Conclusion: after the knee joint surface replacement, the combined infusion of carbamate and normal saline combined with intermittent drainage can effectively reduce postoperative blood loss in patients with TKA.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】