氨甲环酸应用方式对全膝关节置换患者术后失血量的影响

发布时间：2018-03-16 09:29

本文选题：氨甲环酸　切入点：药物疗法　出处：《中国骨与关节杂志》2016年12期 　论文类型：期刊论文

【摘要】：目的探讨氨甲环酸应用方式对人工全膝关节置换术后失血量的影响,并进行安全性评估。方法选取2015年3月至2016年7月符合纳入标准需行单侧全膝关节置换术的78例,按照区组随机法,分为A组、B组、C组,A组在止血带解除前10 min给予氨甲环酸溶液100 ml静滴(氨甲环酸1 g)。B组在止血带释放前假体植入后,切口内予氨甲环酸溶液100 ml(氨甲环酸1 g)浸泡5 min。C组缝合关节囊后通过引流管注入关节腔氨甲环酸溶液100 ml(氨甲环酸1 g),临时夹闭引流管2 h。比较3组术中出血量、隐性失血量、总失血量、术后总引流量、术后血红蛋白水平、输血情况及不良反应发生情况。结果术中失血量:A组(134.88±12.12)ml、B组(131.19±11.02)ml、C组(132.85±10.21)ml,差异无统计学意义(P=0.490.05);术后总引流量:A组(252.27±57.42)ml、B组(208.14±38.62)ml、C组(158.5±20.70)ml,B组、C组低于A组(P=0.000.05);隐性失血量:A组(351.03±89.87)ml、B组(288.96±67.13)ml、C组(180.26±31.33)ml,B组、C组低于A组(P=0.000.05);总失血量:A组(550.65±87.91)ml、B组(458.12±77.30)ml、C组(366.89±70.69)ml,B组、C组低于A组(P=0.000.05)。术后12、24、48 h血红蛋白减少量平均值:A组(24.62±3.51)g/L、B组(21.84±2.81)g/L、C组(17.43±2.24)g/L,B组、C组低于A组(P=0.000.05);术后输血病例A组4例、B组5例、C组2例,输血量B、C组小于A组(P=0.020.05)。3组均无术后感染、肺栓塞及下肢深静脉血栓形成等并发症发生。结论在全膝关节置换术中氨甲环酸应用方式与术后失血量有明显的相关性,局部关节腔注射止血效果优于静脉输液、局部浸泡。
[Abstract]:Objective to investigate the effect of methionine on blood loss after total knee arthroplasty (TKA) and to evaluate its safety. Methods 78 cases of unilateral total knee arthroplasty were selected from March 2015 to July 2016. According to the block method, group A was divided into two groups: group A, group B, group C, group C, group A: 10 min before release of tourniquet, group A were given 100ml intravenous drip of carbamate solution 10 min before release of tourniquet (group B) after implantation of prosthesis before release of tourniquet. The joint capsule was sutured with 100ml of methacylic acid solution (1 g of methacylic acid) for 5 min.C, and then injected into the articular cavity of 100 ml (1 g of ammonia acid) through drainage tube for 2 h. The amount of blood lost in the three groups was compared. Recessive blood loss, total blood loss, postoperative drainage, postoperative hemoglobin level, Results the volume of blood loss in group A was 134.88 卤12.12ml / ml in group B 131.19 卤11.02ml / L group C was 132.85 卤10.21ml / ml, the difference was not statistically significant (P = 0.490.05), and the total postoperative drainage volume was 252.27 卤57.42ml / ml group B group (208.14 卤38.62ml / L) group C group (158.5 卤20.70ml / L) group C was lower than group A (P 0.000.05), and the recessive blood loss volume in group A (351.03 卤89.87ml / ml) group B group (288.96 卤67.13ml / ml) was 180.26 卤31.26 卤31.26 卤31.26 卤31.26 卤31.26 卤38.26 卤31.26 卤38.26 卤31.26 卤38.26 卤38.62ml / ml respectively. The total blood loss of group A was 550.65 卤87.91ml / L group 458.12 卤77.30ml / ml group (366.89 卤70.69ml / ml) was lower than that of group A P0.000.055.The average of hemoglobin reduction at 1224244h in group A was 24.62 卤3.51g / L = 21.84 卤2.81g / L = 21.84 卤2.81g / L respectively. There was no postoperative infection, pulmonary embolism and deep venous thrombosis of lower extremity in group B C less than group A (P 0.020.053.Conclusion there was a significant correlation between the application of methionine in total knee arthroplasty and the amount of blood loss after operation. The hemostatic effect of local articular cavity injection was better than that of intravenous infusion and local immersion.
【作者单位】：陕西中医药大学第二附属医院;核工业二一五医院;
【分类号】：R687.4

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