局部应用氨甲环酸对全膝关节置换术后失血影响的研究

发布时间：2018-05-02 18:02

本文选题：氨甲环酸 + 关节腔内注射　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨术中关节腔内注射氨甲环酸(tranexamic acid,TXA)对减少全膝关节置换术(total knee arthroplasty,TKA)患者术后失血的有效性及安全性。[方法]纳入64例2015年10月-2017年1月在昆明医科大学第二附属医院骨科因重度膝关节骨性关节炎(knee osteoarthritis,KOA)行单侧全膝关节置换术的患者,进行随机双盲对照临床实验。按数字随机表法分为两组:实验组(n=32),其中男性4例,女性28例,年龄52-81岁,平均66.03±8.77岁,左侧19例,右侧13例。对照组(n=32),其中男性3例、女性29例,年龄51-80岁,平均63.84±9.47岁,左侧20例,右侧12例。实验组在缝合关节囊后向关节腔中打入含1g氨甲环酸的“鸡尾酒疗法”50ml,对照组打入单纯“鸡尾酒疗法”50ml。两组患者均用大纱布加压包扎术膝,引流管皆夹闭,4h后改为负压引流。比较两组患者术后1天、3天、出院时血红蛋白和红细胞压积,术中失血量、术后可见失血量、显性失血量,输血量、输血率;术后1天凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、抗凝血酶、凝血酶时间、溶栓二聚体定量、视觉模拟评分、术口延迟愈合率、感染率、下肢深静脉血栓发生率有无统计学差异。[结果]实验组术后可见失血量、显性失血量、输血量、输血率皆低于对照组,两者相比差异有统计学意义(p0.05);实验组术后第1、3天血红蛋白和红细胞压积高于对照组,差异有统计学意义(p0.05);实验组和对照组出院时血红蛋白和红细胞压积,术后一天凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、抗凝血酶、凝血酶时间、溶栓二聚体定量、视觉模拟评分、术口延迟愈合率、感染率、下肢深静脉血栓发生率相比,差异无统计学意义(p0.05)。[结论]局部应用氨甲环酸能有效减少全膝关节置换术后失血和输血率,且不增加术口延迟愈合率、感染率和下肢深静脉血栓发生率,是有效且安全的。
[Abstract]:[objective] to investigate the efficacy and safety of intraarticular injection of tranexamic acidosis (TXA) in reducing postoperative blood loss in patients with total knee arthroplasty. [methods] A randomized double-blind controlled clinical trial was conducted in 64 patients undergoing unilateral total knee arthroplasty in Department of Orthopaedics, second affiliated Hospital of Kunming Medical University from October 2015 to January 2017. According to the digital random table method, the experimental group was divided into two groups: experimental group (n = 4), male (n = 4), female (n = 28), aged 52-81 years (mean, 66.03 卤8.77), left (n = 19) and right (n = 13). In the control group, there were 3 males and 29 females, aged from 51 to 80 years, with an average age of 63.84 卤9.47, left in 20 and right in 12. In the experimental group, 50 ml "cocktail therapy" containing 1 g carbamoic acid was injected into the articular cavity after the joint capsule was sutured, while the control group was injected with the simple "cocktail therapy" of 50 ml. In both groups, the knee was bound with gauze, and the drainage tube was clamped for 4 h and then replaced by negative pressure drainage. The hemoglobin and hematocrit, blood loss, visible blood loss, dominant blood loss, blood transfusion rate, prothrombin time and activated partial thromboplastin time were compared between the two groups 1 day after operation and 3 days after operation. Fibrinogen, antithrombin, thrombin time, thrombolytic dimer quantitative, visual analogue score, operative mouth delayed healing rate, infection rate, lower extremity deep vein thrombosis incidence were statistically different. [results] the blood loss, dominant blood loss and blood transfusion rate in the experimental group were all lower than those in the control group (P 0.05), the hemoglobin and hematocrit in the experimental group were higher than those in the control group on the 1st day after operation. The hemoglobin and hematocrit, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin time, thrombin time, thrombolytic dimer were measured in the experimental group and control group. There was no significant difference in visual analogue score, delayed healing rate, infection rate, and the incidence of deep venous thrombosis in lower extremities (P 0.05). [conclusion] Local application of carbonic acid can effectively reduce the blood loss and blood transfusion rate after total knee arthroplasty without increasing the rate of delayed healing, infection rate and the incidence of deep vein thrombosis of lower extremity, which is effective and safe.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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