全膝关节置换术后氨甲环酸关节腔内注射不同引流管夹闭时间的临床对比研究

发布时间：2018-03-17 00:33

本文选题：全膝关节置换术　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】：研究目的膝关节腔内局部应用氨甲环酸(TXA)降低全膝关节置换术(TKA)后失血量已经在临床上获得了认可,但是关于TKA后膝关节腔内注射TXA联合引流管夹闭时间的系统研究很少。该实验研究全膝关节置换术后氨甲环酸膝关节腔内注射不同的引流管夹闭时间对术后失血量、输血量及并发症等的影响,以选择TKA后TXA膝关节腔内注射引流管夹闭的最佳时间。研究方法选取2015年1月至2016年3月因膝骨关节炎入住青岛大学附属医院关节外科并首次行单侧TKA的患者152例,入院后对152例患者进行术前检查及综合评估,均具有可比性。全部患者于缝合结束后经注射器向膝关节腔内注射TXA注射液(50ml,40 mg/ml)并夹闭引流管,然后绷带加压包扎膝关节并释放止血带。根据释放止血带后引流管夹闭的持续时间将152例患者随机分为4组(夹闭1 h组、夹闭2 h组、夹闭3 h组、夹闭4 h组),各组38例。计算术中出血量、总失血量、术后可见失血量及隐性失血量,统计术后输血、患肢皮下瘀斑、患肢膝关节肿胀及患肢肌间静脉血栓人数,评估术后6月患肢膝关节HSS评分(美国特种外科医院膝关节评分)。由SPSS21.0统计软件包进行数据处理,检验标准为P0.05。研究结果历时15个月,对符合条件的152例患者进行实验并得出数据,对4组数据进行统计学分析得出以下结论:1.在总失血量、术后可见失血量、隐性失血量方面,夹闭3 h组、夹闭4 h组明显低于夹闭1 h组、夹闭2 h组,且夹闭2 h组明显低于夹闭1 h组,夹闭3 h组与夹闭4 h组之间比较差别无统计学意义;2.夹闭4 h组术后患肢皮下瘀斑、患肢膝关节肿胀的发生率显著增加,夹闭1h组术后的输血率明显增加,与其它三组之间比较差别具有统计学意义;3.4组患者的术后患肢肌间静脉血栓及术后6月膝关节HSS评分之间比较,差别无统计学意义。研究结论TKA后TXA膝关节腔内注射联合引流管夹闭3h是最佳选择,既能最大限度的减少术后失血及输血,又可以降低术后并发症的发生。研究意义对全膝关节置换术(TKA)后膝关节腔内注射氨甲环酸(TXA)联合引流管的夹闭时间进行了比较系统性的研究,为今后的进一步临床研究提供帮助。
[Abstract]:Objective to reduce the blood loss after total knee arthroplasty (TKA) by local application of TXA in knee joint. However, there is little systematic study on the time of intraarticular injection of TXA and drainage tube after TKA. This experiment was conducted to study the effect of different entrapment time on postoperative blood loss after total knee arthroplasty. Effects of transfusion volume and complications, In order to select the best time of TXA knee joint drainage tube clamping after TKA. Methods from January 2015 to March 2016, 152 patients who were admitted to the Department of Arthroplasty in the affiliated Hospital of Qingdao University and underwent unilateral TKA for the first time were selected. The preoperative examination and comprehensive evaluation of 152 patients after admission were comparable. After suture, all patients were injected with TXA injection 50 mg / ml of 40 mg / ml into the knee joint via syringe and the drainage tube was clamped. According to the duration of drainage tube clamping, 152 patients were randomly divided into 4 groups (1 h clipping group, 2 h clipping group, 3 h clipping group). 38 cases of each group were clamped for 4 h. The amount of blood loss during operation, the total amount of blood loss, the amount of blood loss and recessive blood loss, blood transfusion, subcutaneous ecchymosis of the affected limb, swelling of the knee joint of the affected limb and the number of intermuscular venous thrombosis of the affected limb were calculated. The HSS score of the knee joint of the affected limb was evaluated on June. The data were processed by the SPSS21.0 statistical software package. The results of the study lasted for 15 months. 152 eligible patients were tested and the data were obtained. The following conclusions were drawn by statistical analysis of 4 groups of data: 1. In the total blood loss, the visible blood loss after operation, and the hidden blood loss, the 3 h group was clamped up. 4 h group was significantly lower than 1 h group, 2 h group was significantly lower than 1 h group, and 2 h group was significantly lower than 1 h group. There was no significant difference between 3 h group and 4 h group. 2. Subcutaneous ecchymosis of the affected limb in 4 h clipping group was significantly lower than that in the 2 h group, and there was no significant difference between 3 h group and 4 h group. The incidence of knee joint swelling in the affected limbs was significantly increased, and the blood transfusion rate was significantly increased in the group of 1 hour clipping. Compared with the other three groups, the difference was statistically significant between the patients with postoperative intermuscular venous thrombosis and the HSS score of knee joint on June. Conclusion Intra-articular injection of TXA combined with entrapment of drainage tube for 3 hours after TKA is the best choice, which can minimize postoperative blood loss and blood transfusion. The significance of this study was to study the clamping time of intraarticular injection of TXA and drainage tube after total knee arthroplasty. It will be helpful for further clinical research in the future.
【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

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