全髋关节置换术中全身及局部联合应用氨甲环酸的止血效果观察

发布时间：2018-03-13 02:01

本文选题：髋关节置换术　切入点：氨甲环酸　出处：《山东医药》2017年07期 　论文类型：期刊论文

【摘要】：目的观察全髋关节置换术(THA)中静脉滴注联合局部注射氨甲环酸(TXA)的止血效果。方法 110例拟行初次单侧THA的患者随机分为A组40例、B组40例、C组30例,A组THA切皮前10 min静脉滴注15 mg/kg TXA,B组于THA术缝皮结束后向关节腔内局部注射1.5 g TXA,C组行静脉滴注联合局部注射TXA。观察并记录三组手术时间、围手术期总失血量、围手术期输血情况、术后24 h引流量及术后Hb下降最大值。术后第5天采用VAS疼痛评分、术后1个月采用Harris评分评价三组疼痛情况。观察三组术后3个月双下肢深静脉血栓(DVT)及症状性肺栓(PE)发生情况。结果 A、B、C组手术时间比较,P均0.05。A、B、C组围手术期总失血量分别为(886.20±35.58)、(971.87±68.55)、(773.89±58.60)m L,组间两两比较,P均0.05;围手术期输血率分别为14.29%(5/40)、21.21%(7/40)、7.14%(2/30),C组术后Hb下降最大值低于A、B组,P均0.05;术后24 h引流量分别为(223.68±26.46)、(198.41±15.42)、(175.84±17.94)m L,组间两两比较,P均0.05。术后第5天A组VAS评分高于B、C组,P均0.05。结论 THA术中静脉滴注联合局部注射TXA的止血效果较好,可降低围手术期总失血量、术后引流量且不增加血栓事件发生率,效果优于单纯静脉滴注或局部注射。
[Abstract]:Objective to observe the hemostatic effect of intravenous drip combined with local injection of TXA in total hip arthroplasty. Methods 110 patients with primary unilateral THA were randomly divided into group A (n = 40), group B (n = 40) and group C (n = 30) with THA incision. The first 10 min intravenous drip of 15 mg/kg TXAZA B group was given intraarticular intraarticular injection of 1.5 g TXA after the end of THA suture skin. The time of operation was observed and recorded in the three groups after intravenously infusion combined with local injection of TXA.The operation time of the three groups was observed and recorded. The total blood loss during perioperative period, blood transfusion during perioperative period, drainage flow at 24 hours after operation and the maximum decrease of HB were observed. VAS pain score was used on the 5th day after operation. One month after operation, the pain status of the three groups was evaluated with Harris score. The incidence of DVT and symptomatic pulmonary embolism in the three groups were observed 3 months after operation. The blood volume was 886.20 卤35.58m / L, 773.89 卤58.60 mL / L, respectively, and the blood transfusion rate was 14.296.20 卤35.58 + 21.21 / 7 / 7 / 7 / 7.142.22 / 30 ~ 30C (P < 0.05) respectively. 24 hours after operation, the volume of blood flow was 223.68 卤26.466.46. 41 卤15.42 卤175.84 卤17.94 mL / L, respectively, and the two groups were compared with each other (P = 0.05). At the 5th day after operation, the peak value of HB in group A was lower than that in group A (P = 0.05), and the volume of drainage at 24 hours after operation was 223.68 卤26.460.42 卤15.42.84 卤17.94 mL, respectively, and the difference between the two groups was 0.050.The maximum value of HB in group C was lower than that in group A (P = 0.05), and that in group A was lower than that in group A at 24 hours after operation. The score of VAS in group B was higher than that in group B C (P 0.05). Conclusion the hemostatic effect of intravenous drip combined with local injection of TXA during THA operation is better. It can reduce the total blood loss in perioperative period, drain flow after operation and do not increase the incidence of thrombotic events, and the effect is better than that of intravenous drip or local injection alone.
【作者单位】：安徽医科大学第一附属医院;
【分类号】：R687.4

【参考文献】