鸡尾酒疗法减少全膝关节置换后隐性失血

发布时间：2018-04-16 17:36

本文选题：关节成形术 + 膝　；参考：《中国组织工程研究》2017年03期

【摘要】：背景:全膝关节置换术后失血是比较常见的临床问题,会影响患者的置换效果。氨甲环酸作为一种止血药物,越来越多的被应用于减少人工关节置换术后出血,但是对同时使用氨甲环酸和其他药物止血效果的研究还很少。目的:评估初次单侧全膝关节置换术中局部应用鸡尾酒(氨甲环酸和肾上腺素混合液)对减少患者围手术期失血量、降低输血率的有效性和安全性。方法:将中日友好医院骨关节外科2013年7月至2015年10月入院拟行初次单侧全膝关节置换的113患者随机分为鸡尾酒组(57例)和氨甲环酸组(56例)。手术过程中在鸡尾酒组患者关节腔内注射鸡尾酒[3 g氨甲环酸和0.25 mg稀释肾上腺素(1∶200 000)的混合溶液],氨甲环酸组关节腔内单纯注射3 g氨甲环酸溶液,所有患者置换术后均不放置引流管。围手术期观察患者术中失血量、术后显性失血量、隐性失血量及异体输血量;在术后90 d内,观察患者有无症状性深静脉血栓和肺动脉栓塞的发生。结果与结论:(1)全膝关节置换时,与单纯局部应用氨甲环酸相比,鸡尾酒组患者手术总失血量(P=0.007)、隐性失血量(P=0.000)以及术后异体输血率(0%vs.5.4%)均较低,并且不增加患者血栓栓塞及血栓形成等并发症的风险(P0.05);(2)结果提示,全膝关节置换时稀释肾上腺素联合使用氨甲环酸的止血效果优于单纯使用氨甲环酸,而且不会产生严重的不良反应,可作为减少全膝关节置换术后失血的重要方法。
[Abstract]:Background: blood loss after total knee arthroplasty is a common clinical problem, which affects the outcome of replacement.As a kind of hemostatic drugs, carbamate has been used more and more to reduce bleeding after artificial joint replacement, but little research has been done on the hemostatic effect of combined use of carbamate and other drugs.Objective: to evaluate the efficacy and safety of local use of cocktails in the initial unilateral total knee arthroplasty (TKA) for reducing perioperative blood loss and reducing blood transfusion rate.Methods: from July 2013 to October 2015, 113 patients with primary unilateral total knee arthroplasty in Sino-Japanese Friendship Hospital were randomly divided into cocktail group (n = 57) and amacylic acid group (n = 56).During the operation, the patients in the cocktail group were injected intraarticularly with a mixture of 3 g carbamoic acid and 0.25 mg diluted epinephrine (1: 200 000).No drainage tube was placed in all patients after replacement.The amount of blood loss during operation, the amount of apparent blood loss, the amount of recessive blood loss and the amount of allogeneic blood transfusion were observed during the perioperative period, and the occurrence of symptomatic deep vein thrombosis and pulmonary embolism was observed within 90 days after operation.Results the total blood loss and recessive blood loss during total knee arthroplasty in cocktail group were significantly lower than those in the control group (P < 0. 007, P = 0. 000), and the rate of allogeneic blood transfusion after total knee arthroplasty was lower than that in the control group (P < 0. 007, P < 0. 000) and the rate of allogeneic blood transfusion was lower than that in the control group (P < 0. 0vs.5. 4).The results showed that the hemostatic effect of diluting epinephrine combined with carbamate in total knee arthroplasty was better than that of simple use of carbamoic acid, and did not increase the risk of complications such as thromboembolism and thrombosis.It can be used as an important method to reduce blood loss after total knee arthroplasty.
【作者单位】：北京大学医学部中日友好临床医学院;北京中日友好医院骨关节外科;
【基金】：国家自然科学基金面上项目(81372013) 中日友好医院院级课题(2014-4-QN-29);中日友好医院青年科技英才计划(2014-QNYC-A-06)~~
【分类号】：R687.4

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