氨甲环酸减少全膝关节置换术失血量的临床研究

发布时间：2018-04-09 06:30

本文选题：全膝关节置换　切入点：氨甲环酸　出处：《浙江大学》2015年博士论文

【摘要】：目的探究全膝关节置换术中应用抗纤维蛋白溶解药物氨甲环酸对出血量的影响。方法回顾性研究2011年1月1日至2014年5月1日间,因膝骨关节炎就诊于浙江大学附属第二医院骨科并行初次单侧全膝关节置换的病例,共有134例符合标准纳入研究。依是否使用氨甲环酸以及氨甲环酸不同的使用方式分为静脉使用组(50例,松止血带前氨甲环酸400mg/100mL生理盐水静脉滴注),局部加静脉联合组(45例,假体置入前氨甲环酸400mg/40mL生理盐水关节腔周围组织注射+松止血带前氨甲环酸400mg/100mL生理盐水静脉滴注)和对照组(39例,不使用氨甲环酸)。分析不同组间患者一般情况、术前血化验指标。对比患者术后48小时引流量、术后72小时总红细胞丢失量、显性红细胞丢失量、隐性红细胞丢失量、输血率、人均输血量、住院时间和住院费用。统计患者出现深静脉血栓形成、肺动脉栓塞、切口并发症等情况。结果三组患者在一般情况(性别比例、年龄、身高、体重、体重指数)、术前血化验指标(血红蛋白、红细胞比容、血小板计数、凝血酶原时间)及手术时间上均无显著性差异。联合组术后48小时引流量较对照组显著降低(267.00±107.69mL vs.337.95±148.84mL, P0.05)。联合组较对照组在总红细胞丢失量(304.29±116.21mL vs.495.72±254.19mL, P0.05)、显性红细胞丢失量(132.34±41.73mL vs.159.48±58.10mL, P0.05)和隐性红细胞丢失量(165.28±103.34mL vs.336.23±234.73mL, P0.01)上均显著降低。静脉组较对照组在总红细胞丢失量(352.04±158.04mL vs.495.72±254.19mL, P0.05)和隐性红细胞丢失量(208.51±148.36mL vs.336.23±234.73mL, P0.01)上显著降低,在显性红细胞丢失量(143.53±50.45mL vs.159.48±58.10mL, P0.05)上无显著差异。静脉组和联合组均显著降低了术后输血率、人均输血量、住院时间和住院费用。结论在初次单侧全膝关节置换术中,静脉使用氨甲环酸,或联合关节腔周围局部使用,可以显著减少术后红细胞丢失量和异体输血率,且不增加血栓栓塞以及术后感染等并发症的发生率,同时显著降低了住院时间和住院费用。两种应用氨甲环酸的方式在减少红细胞丢失量方面并不存在显著差异。
[Abstract]:PurposeTo investigate the effect of anti-fibrinolysis drug carbamate on blood loss in total knee arthroplasty.MethodFrom January 1, 2011 to May 1, 2014, 134 patients with knee osteoarthritis treated in the Department of Orthopaedics of the second affiliated Hospital of Zhejiang University combined with the initial unilateral total knee arthroplasty were included in the study.According to whether or not to use methacylic acid or not, the patients were divided into intravenous group (n = 50), 400mg/100mL group (n = 45) and local combined group (n = 45).Prostheses were implanted into the periarticular tissues of promethylate 400mg/40mL saline) and the control group (39 cases) were treated by intravenous drip of 400mg/100mL (a loose tourniquet).Analysis of the general situation of different groups of patients, preoperative blood test indicators.The amount of total red blood cell loss, dominant red blood cell loss, recessive red blood cell loss, blood transfusion rate, per capita blood transfusion volume, hospital stay time and hospitalization cost were compared at 48 hours after operation, 72 hours after operation.Patients with deep venous thrombosis, pulmonary embolism, incision complications, and so on.ResultThere was no significant difference in general condition (sex ratio, age, height, weight, body mass index, preoperative blood test index (hemoglobin, erythrocyte volume, platelet count, prothrombin time) and operative time) among the three groups.Compared with the control group, the drainage flow at 48 hours after operation in the combined group was significantly lower than that in the control group (267.00 卤107.69mL vs.337.95 卤148.84mL, P 0.05).Compared with the control group, the total RBC loss of 304.29 卤116.21mL vs.495.72 卤254.19 mL, P0.05, dominant RBC loss 132.34 卤41.73mL vs.159.48 卤58.10 mL, P0.05) and recessive RBC loss of 165.28 卤103.34mL vs.336.23 卤234.73mL, P0.01) were significantly decreased in the combined group than in the control group.Compared with the control group, the total RBC loss was 352.04 卤158.04mL vs.495.72 卤254.19mL (P0.05) and the occult RBC loss was 208.51 卤148.36mL vs.336.23 卤234.73mL, P0.01), but there was no significant difference in the dominant RBC loss (P 0.05) at 143.53 卤50.45mL vs.159.48 卤58.10mL.The blood transfusion rate, blood transfusion volume per capita, hospital stay and hospitalization cost were significantly decreased in both intravenous and combined groups.ConclusionIn the first unilateral total knee arthroplasty, intravenous use of carbamoic acid or local use in combination with articular cavity can significantly reduce the amount of red blood cells lost and the rate of allogeneic blood transfusion after surgery.The incidence of complications such as thromboembolism and postoperative infection was not increased, and the hospitalization time and cost were significantly reduced.There was no significant difference between the two methods in reducing erythrocyte loss.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.4

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