氨甲环酸与镇痛鸡尾酒在全膝关节置换术中局部联合应用的研究

发布时间：2018-05-07 02:37

本文选题：氨甲环酸 + 关节成形术　；参考：《第三军医大学》2017年硕士论文

【摘要】：研究背景及目的多年来失血和疼痛一直是是全膝关节置换术(TKA)后的两个主要问题。但是目前,临床上应用氨甲环酸来减少全膝关节置换术后出血,被证明是安全和有效的。局部应用镇痛鸡尾酒不仅可以减轻术后膝关节疼痛,还可减少术后失血。关于两者局部联合应用的研究较少。本研究主要探讨局部应用氨甲环酸(TXA)复合镇痛鸡尾酒对减少全膝关节置换术后失血有效性及安全性的影响。方法将2015年8月—2016年6月期间拟在第三军医大学附属新桥医院行TKA的膝骨关节炎患者共计60例纳入研究,其中男性13例,女性47例;退行性骨关节炎16例,创伤性骨关节炎44例;年龄51~80岁,平均65.6岁。采用随机数字表法随机分为两组,A组为单用镇痛鸡尾酒组(30例),于TKA术中置入假体前在膝关节内多点注射镇痛鸡尾酒;B组为局部联合应用氨甲环酸和镇痛鸡尾酒组(30例),于TKA术中置入假体前在膝关节内多点注射氨甲环酸复合镇痛鸡尾酒。比较两组术中失血量、术后引流量、隐性失血量、术后总失血量、血红蛋白变化值、Hct变化值、特种外科医院(HSS)膝关节评分、输血率、深静脉血栓(DVT)及其他并发症发生率。结果B组围手术期Hb的降低值为18.5(13.0,26.0)g/L,少于A组的23.0(21.0,35.5)g/L(P0.05)。Hct的降低值,B组为5.6(4.1,7.8)%,明显少于A组的7.2(6.1,10.7)%(P0.05)。B组的术后引流量为105.0(60.0,223.8)ml,A组为162.5(118.8,245.0)ml,B组明显较少(P0.05)。在总失血量上,B组为596.0(426.1,795.3)ml,A组为788.3(583.0,1082.4)ml,前者明显少于后者(P0.05)。B组的隐性失血量为422.3(228.9,624.0)ml,少于A组的603.2(435.2,884.7)ml(P0.05)。在术中失血量、HSS膝关节评分、输血率、DVT及其他并发症发生率上差异无统计学意义(P0.05)。结论在全膝关节置换术中局部联合应用氨甲环酸和镇痛鸡尾酒可减少围手术期失血,并且不增加术后深静脉血栓发生的风险。
[Abstract]:Background and objective Blood loss and pain have been two major problems after total knee arthroplasty (TKA) for many years. At present, the clinical application of carbamoic acid to reduce bleeding after total knee arthroplasty has proved to be safe and effective. Local application of analgesic cocktail can not only reduce postoperative knee pain, but also reduce postoperative blood loss. There are few studies on the local combination of the two. The purpose of this study was to investigate the effect of local application of TXA compound analgesia cocktail on the efficacy and safety of reducing blood loss after total knee arthroplasty. Methods A total of 60 patients with knee osteoarthritis, including 13 males and 47 females and 16 patients with degenerative osteoarthritis, were enrolled in the study from August 2015 to June 2016 at Xinqiao Hospital affiliated to the third military Medical University. There were 44 cases of traumatic osteoarthritis, the age was 51 ~ 80 years (mean 65.6 years). Two groups were randomly divided into two groups: group A: single analgesic cocktail group (n = 30). Before implantation of prosthesis during TKA, analgesia cocktails were injected into the knee joint. Group B was used locally as a combination of triacycline and analgesic cocktails. Group A (n = 30) were treated with multiple injection of carbamocytic acid (MA) combined with analgesia cocktails in knee joint before implantation of prosthesis during TKA. The blood loss, postoperative drainage, recessive blood loss, total blood loss, hemoglobin change value and HSS knee joint score, blood transfusion rate, DVT (DVT) and other complications were compared between the two groups. Results the decreasing value of HB in group B was 18.5- 13.0 / 26.0g / L, which was less than that of group A (23.021.0g / L, 35.5g / L). The decrease of HB in group B was 5.64.1g / L ~ 7.8g / L, which was significantly lower than that in group A (7.26.110.7a) and the postoperative drainage volume of group A was 105.60.0223.8ml / L (162.5 / 118.245.0ml / L) compared with that of group A (P 0.05 / 0.05ml / L, P = 0.05), and that of group B was significantly lower than that of group B (P = 0.05). The postoperative drainage volume of group B was significantly lower than that of group B (P < 0.05), and that of group B was significantly lower than that of group B (P < 0.05). The total amount of blood loss in group B was 596.0 / 426.1795.3ml / ml, 788.3n / 583.0N / 1082.4 / ml, respectively, which was significantly lower than that in group B (422.3228.24.960ml) and 603.2435.2884.7ml / ml (P0.05N), respectively, compared with that in group A (P0.05ml, P 0.05), and that in group B was less than that in group B (P < 0.05), and that in group B was less than that in group B (P < 0.05). There was no significant difference in HSS score, blood transfusion rate, DVT and other complications during operation (P 0.05). Conclusion Local application of carbamoic acid and analgesic cocktail in total knee arthroplasty can reduce perioperative blood loss and does not increase the risk of postoperative deep venous thrombosis.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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