不同时间段静滴氨甲环酸对同期双膝关节置换术有效性及安全性的回顾性对照分析

发布时间：2018-03-25 02:00

本文选题：氨甲环酸　切入点：双侧膝关节置换术　出处：《暨南大学》2015年硕士论文

【摘要】：目的比较同期双侧膝关节表面置换不同时间点静滴氨甲环酸对围手术期出血及术后静脉血栓栓塞发生率的影响。方法1、回顾性分析2012年9月至2014年12月间初次行双膝关节置换患者32例,按照之前用药方案分四组;2、用药方案分组:A组(11例)在手术开始前30分钟及手术结束缝合术口前30分钟静脉使用氨甲环酸;B组(7例)在手术开始前30分钟静滴氨甲环酸;C组(8例)手术结束缝合术口前30分钟静滴氨甲环酸(单次剂量均为15mg/kg);D组(6例)为不使用氨甲环酸;3、记录各组术后24小时引流量及总引流量,术后输血率,术后24小时、72小时及1周的血红蛋白值;4、检测术后24h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体,术后24小时、3天、1周的疼痛VAS评分及术后3d患膝被动活动度,静脉血栓栓塞(VTE)发生率。结果1、A、B、C组的术后24h的平均引流量、总引流量、输血率分别少于D组,其中A组最少(P0.05)。2、A组术后24h、72h的Hb值明显高于B、C、D组(P0.05)。D组术后D-二聚体明显高于A、B、C组(P0.05),A、B、C组间比较差异无统计学意义(P0.05);3、A组术后24h疼痛VAS评分明显低于B、C、D组(P0.05);术后输血率A组2人(18%)、B组3人(43%)、C组3人(37%)、D组3人(50%)。术后24h的PT、APTT、FIB、术后3d患膝主被动活动度四组间比较无统计学意义(P0.05)。4、四组患者均未出现VTE临床症状,术后2周彩超检测下肢动静脉未见血栓形成。结论1、氨甲环酸在减少同期双膝关节表面置换术后围手术期失血和输血率的同时,并不增加VTE的发生率和影响术膝术后早期功能锻炼。2、其中术前30min与关闭切口前30min静滴氨甲环酸这种方法效果较佳,值得推广应用。
[Abstract]:Objective to compare the effects of intravenously instilled methionine on the incidence of perioperative hemorrhage and postoperative venous thromboembolism in patients with bilateral knee joint surface replacement at different time points. Methods 1. The first time between September 2012 and December 2014 was analyzed retrospectively. 32 patients with double knee arthroplasty, According to the previous regimen, 7 patients in group B received intravenously ammonia 30 minutes before the operation and 30 minutes before the end of the operation.) 30 minutes before the operation began, 7 patients in group B received intravenous drip of ammonia. Group C (n = 8) were treated with intravenously dripping methacylic acid 30 minutes before the end of suture (6 cases in group D with a single dose of 15 mg / kg). The drainage volume and total drainage flow were recorded 24 hours after operation in each group. The blood transfusion rate, the hemoglobin values of 24 hours, 72 hours and 1 week after operation were measured. The prothrombin time (PTT), activated partial thromboplastin time (APTT), fibrinogen fibrinogen (FIBF) and D-dimer (Ddimer) were measured. The VAS score of pain and the incidence of passive knee motion and venous thromboembolism (VTE) were measured at 24 hours and 3 days after operation. Results 1 the mean drainage flow, total drainage volume and blood transfusion rate in group C were lower than those in group D, respectively. The HB value in group A was significantly higher than that in group A at 24 hours after operation, and that in group D was significantly higher than that in group A (P 0.05). There was no significant difference between group A and group A (P 0.053A, P 0.053A), and the postoperative blood transfusion rate (A) was significantly lower than that in group B (P 0.053A), and the postoperative blood transfusion rate (A) was significantly higher than that in group A (P 0.05), and the postoperative blood transfusion rate (A) was significantly higher than that in group A (P 0.053A), and the postoperative blood transfusion rate (A) was significantly higher than that in group A (P 0.05). Group B (n = 3) and group C (n = 3), group D (n = 3) and group D (n = 3). There was no significant difference in the active and passive activity of the knee between the four groups on the 3rd day after operation (P 0.05). No clinical symptoms of VTE were found in all the four groups. Conclusion: 1. The rate of blood loss and blood transfusion during the perioperative period after double knee joint surface replacement was decreased. The incidence of VTE was not increased and the early functional exercise of knee was not affected. Among them, 30min before operation and 30min before closure of incision had better effect, which was worth popularizing.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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