氨甲环酸两种用药途径在减少单侧TKA术后出血的应用研究

发布时间：2018-04-13 20:27

本文选题：氨甲环酸 + 膝关节置换　；参考：《青岛大学》2017年硕士论文

【摘要】：背景目前全膝关节置换已成为治疗各种膝关节终末期病变最有效的手术方式,膝关节围手术期失血一直是困扰关节外科医生常见问题,氨甲环酸减少术后出血的作用日益受到重视,但对于选用何种用药途径仍存在争议目的探讨氨甲环酸静脉给药及关节腔注射两种不同给药途径对降低TKA术中、术后失血量的影响。方法选取60例2015年10月至2016年10月拟行单侧全膝关节置换的患者,按性别以分层随机分组法分成3组:A组(n=20):不应用氨甲环酸;B组(n=20):应用手术切皮前缓慢静滴15 mg/kg氨甲环酸,术后3 h再给予10 mg/kg氨甲环酸;C组(n=20):封闭关节腔后经引流管注入稀释在50 ml生理盐水1g氨甲环酸,3组均在术后夹闭引流管2 h。记录各组置换后显性失血量、隐性失血量、输血比率、输血量,同时观察是否有肺栓塞及下肢深静脉栓塞的临床症状。结果术后3-5天失血量达峰值,显性失血量约占总失血量三分之一。B组及C组患者同A组相比,显性失血量和隐性失血量均明显减少,差异有显著性意义(P0.05);B组与C组在显性失血量方面差异无显著性意义(P0.05),在隐性失血量方面B组显著小于C组(P0.05);B组及C组患者输血人数及输血比率明显小于A组,差异有显著性意义(P0.05);3组患者术后2周,行双下肢深静脉血管彩超复查,均未发现DVT形成。结论氨甲环酸能明显减少初次单侧人工全膝关节置换的围手期失血量、输血率及人均输血量,且不增加DVT形成、PE的风险,且静脉给药效果更好。
[Abstract]:Background Total knee arthroplasty (TKR) has become the most effective method for the treatment of various end-stage diseases of knee joint. Perioperative bleeding of knee joint has been a common problem for joint surgeons.More and more attention has been paid to the effect of methacylic acid on the reduction of postoperative bleeding. But there are still some controversial aims to explore the two different ways of intravenously administration and intraarticular injection of carbamate in the reduction of TKA.The effect of blood loss after operation.Methods 60 patients with unilateral total knee arthroplasty from October 2015 to October 2016 were randomly divided into three groups according to their sex: group A: group B was treated with carbampicycline group B and group B was given intravenously intravenously for 15 mg/kg before skin incision.Three hours after operation, group C was given 10 mg/kg of methoxycycline for 10 mg/kg. After articular cavity closure, drainage tube was injected and diluted into 50 ml normal saline (1 g). The drainage tube was clamped for 2 h.The apparent blood loss, recessive blood loss, blood transfusion ratio and blood transfusion volume were recorded after replacement. The clinical symptoms of pulmonary embolism and deep vein embolism of lower extremity were observed at the same time.Results the amount of blood loss reached the peak at 3-5 days after operation. The amount of dominant blood loss in group B and group C was significantly lower than that in group A (1/3. B) and group C (P < 0.05), and the amount of dominant blood loss and recessive blood loss in group C were significantly lower than those in group A (P < 0.05).There was no significant difference in the apparent blood loss between group B and group C, but the number and ratio of blood transfusion in group B was significantly lower than that in group C (P 0.05).There was a significant difference in P0.05 group 2 weeks after operation, two weeks after the examination of the deep veins of the lower extremities, no DVT was found.Conclusion the blood loss, blood transfusion rate and blood transfusion volume per person in the first unilateral total knee arthroplasty can be significantly reduced, and the risk of the formation of PE in DVT is not increased, and the effect of intravenous administration is better.
【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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