活血化瘀中药对全膝关节置换术后隐性失血的影响分析

发布时间：2018-06-04 11:16

本文选题：膝骨性关节炎 + 全膝关节置换术　；参考：《广州中医药大学》2015年硕士论文

【摘要】：目的：本研究拟对全膝关节置换(Total Knee Arthroplasty TKA)患者在术中及术后使用止血药(氨甲环酸(Tranexamic Acid TXA))进行评估,评价其对术后隐性出血隐性失血(Hidden Blood Loss HB L)的影响及安全性。同时对全膝关节置换术患者术后使用活血化瘀中药预防深静脉栓塞(Deep Vein Thrombosis DVT),评估其对术后隐性失血的影响及安全性,为活血化瘀中药在人工关节围手术期中的应用提供依据。方法：采用随机对照研究设计方案选择符合纳入标准的膝关节骨性关节炎患者,并于我院行单侧TKA的病例共90例做为研究的对象。其中A组：活血化瘀中药组,30例；B组：活血化瘀中药联合氨甲环酸治疗组,30例；C组：生理盐水对照组,30例。三组患者均由同一主刀施行手术,术后三组患者都进行一致的康复锻炼计划,术后均约2周出院。分析患者手术前的病情,将资料进行量化,再通过采用SPSS17.0统计软件进行分析三组病例的术前病情资料,进行样本同质性比较,若分析结果提示三组病人的术前病情资料具有可比性,就进一步分析A组与B组资料,总失血量、显性失血量、隐性失血量、输血率、住院天数、深静脉栓塞事件及出血并发症等资料有无统计学差异；A组与C组相比,总失血量、显性失血量、隐性失血量、输血率、住院天数、皮下瘀斑率及出血并发症等资料有无统计学差异。结果：经统计分析,三组病例患者的患者性别、年龄、患膝侧别(左右)、身高、体重、体重指数(Body Mass Index BMI)、年龄组别(小于60岁,大于60岁)、术前Hss评分、手术切口、手术时间、术前血色素、术前Hct、术前D二聚体、合并内科疾病(高血压、糖尿病、高血压及糖尿病、无高血压及糖尿病)等资料均无统计学差异性(P0.05),三组资料具备可比性。所有病例失血量所占百分比：显性失血量所占百分比：27.70±11.35%；隐性失血量所占百分比：72.38±11.26%。A组与B组、A组与C组两对照组比较,发现其显性失血量所占百分比及隐性失血量所占百分比差异无统计学意义(P0.05)。说明使用氨甲环酸或活血化瘀中药对TKA术后显性失血量所占百分比及隐性失血所占百分比无明显影响。根据围手术期监测血常规情况,发现术后三组患者的血色素及Hct平均值最低点主要集中在第三天,术后第七天趋势基本平缓。比较氨甲环酸对TKA术后隐性失血的影响,发现B组较A组术后总失血量平均减少211.86ml,隐性失血量平均减少160.28ml,住院天数平均减少2.4天,(P0.05),差异有统计学意义。但显性失血量、术后引流量、输血率及皮下瘀斑率差异无统计学意义。且研究对象均未出现DVT事件。说明氨甲环酸可以有效减少TKA术后失血总量、隐性失血量及住院天数,且其安全性良好。比较活血化瘀中药对隐性失血的影响,发现A组较C组总失血量平均增加225.69ml,隐性失血量平均增加167.66ml,(P0.05),差异有统计学意义。但显性失血量、住院天数、术后引流量、输血率及皮下瘀斑率差异无统计学意义。且研究对象均未出现DVT事件及大失血并发症。说明活血化瘀中药在良好的预防TKA术后DVT的同时,会增加TKA术后失血总量、隐性失血量。结论：根据研究结果发现,隐性失血占有TKA术后失血量的绝大部分。术后血色素及Hct最低值主要集中在术后第三天。氨甲环酸可明显减少围手术期失血量,减少住院天数,且并未增加DVT风险,故氨甲环酸安全有效,是一种值得推广的控制围手术期失血的药物。活血化瘀中药在良好的预防TKA术后静脉栓塞事件的同时,会增加TKA术后失血总量、隐性失血量。故使用活血化瘀中药同时需密切监测患者血色素情况,及时补充因隐性失血导致的血容量下降。
[Abstract]:Objective: To evaluate the effect and safety of Total Knee Arthroplasty TKA on recessive hemorrhage (Hidden Blood Loss HB L) for postoperative recessive hemorrhage (Hidden Blood Loss HB L) in patients with total knee replacement (Tranexamic Acid TXA), and to evaluate the effect and safety of the patients with recessive hemorrhage (Hidden Blood Loss HB L) after operation. To prevent deep venous embolism (Deep Vein Thrombosis DVT) and evaluate its effect on postoperative recessive blood loss and its safety, to provide basis for the application of Chinese medicine for activating blood and removing stasis in the perioperative period of artificial joint. A total of 90 cases of unilateral TKA were studied in our hospital, of which group A: group of Chinese medicine for activating blood and removing stasis, 30 cases; group B: group of activating blood and removing blood stasis combined with methicyclic acid treatment group, 30 cases; group C: normal saline control group and 30 cases. All three groups were operated by the same main knife, and the three groups of patients all carried out a consistent rehabilitation exercise plan after the operation. After 2 weeks, the patients were discharged about 2 weeks. Analyze the patient's condition before operation, quantify the data, and then analyze the preoperative data of the three groups by using the statistical software of SPSS17.0, and compare the homogeneity of the samples. If the analysis results suggest that the data of the three groups are comparable, the data of the group A and the group of B are further analyzed and the total blood loss is analyzed. Quantity, dominant blood loss, recessive blood loss, blood transfusion rate, hospitalization days, deep venous embolism events and bleeding complications, and other data were not statistically different. Compared with group C, there were no statistical differences in total blood loss, dominant blood loss, recessive blood loss, blood transfusion rate, hospitalization days, subcutaneous ecchymosis and bleeding complications. Analysis, three groups of cases of patients with sex, age, knee side (left and right), height, weight, body mass index (Body Mass Index BMI), age group (less than 60 years old, more than 60 years old), preoperative Hss score, surgical incision, operation time, preoperative hemoglobin, preoperative Hct, preoperative D two polymer, combined with internal medical diseases (hypertension, diabetes, hypertension and diabetes) There was no statistical difference in the data of disease, hypertension and diabetes mellitus (P0.05). The percentage of all the three groups was comparable. The percentage of all cases of blood loss: the percentage of dominant blood loss was 27.70 + 11.35%, the percentage of recessive blood loss was 72.38 + 11.26%.A and B, and the dominant blood loss was found in group A and C group. The percentage of the percentage and the percentage of recessive blood loss had no significant difference (P0.05). It showed that the percentage of dominant blood loss and the percentage of recessive blood loss were not significantly affected by the use of methicyclic acid or activating blood circulation to remove blood stasis. The hemoglobin and Hct in the three groups of patients after the perioperative period were detected. The mean lowest point was mainly concentrated at third days and the trend of seventh days after operation was basically slow. Comparing the effect of methicinic acid on the recessive blood loss after TKA, it was found that the total loss of blood in group B decreased by 211.86ml, the average loss of recessive blood loss was 160.28ml, the average number of hospitalization days decreased by 2.4 days, (P0.05), but the difference was statistically significant. However, the dominant loss of blood was statistically significant. There was no significant difference in volume, postoperative flow rate, blood transfusion rate and subcutaneous ecchymosis. And no DVT events were found in the subjects. It was suggested that methicyclic acid could effectively reduce the total amount of blood loss, the amount of recessive blood loss and the days of hospitalization, and the safety of the patients after TKA. The comparison of the effect of the Chinese medicine for activating blood and removing stasis on the recessive blood loss was found, and the total loss of blood in the group A was compared with that of the group C. The average increase of 225.69ml, the average amount of recessive blood loss increased by 167.66ml, (P0.05), and the difference was statistically significant. However, there was no significant difference between the dominant blood loss, the days of hospitalization, the postoperative flow rate, the rate of blood transfusion and the subcutaneous ecchymosis. And there were no DVT events and large hemorrhagic complications. DVT also increased the total amount of blood loss and recessive blood loss after TKA. Conclusion: according to the results, recessive blood loss accounts for most of the amount of blood loss after TKA. The postoperative hemoglobin and Hct minimum are mainly concentrated at third days after the operation. Methicinic acid can significantly reduce the perioperative loss of blood, reduce the number of days in hospital, and do not increase the risk of DVT. Therefore, it is a safe and effective drug that is worth popularizing in the perioperative period to control the blood loss in the perioperative period. The Chinese medicine for activating blood and removing stasis can increase the total amount of blood loss and recessive blood loss after the operation of TKA after the operation of TKA, so the use of the Chinese medicine for activating blood and removing stasis needs to monitor the hemoglobin and supplement the recessive situation in time. Blood loss caused by blood loss is decreasing.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

【参考文献】