两种不同引流方式在全膝关节置换术后患者中的应用比较

发布时间：2018-06-04 12:12

本文选题：全膝关节置换术 + 负压引流　；参考：《浙江大学》2015年博士论文

【摘要】：研究目的：分析比较全膝关节置换术后两种不同引流方式的临床疗效,为TKA术后引流方式的选择提供一定的参考价值。研究方法：回顾性收集2014年1月1日至2015年3月1日于浙江大学医学院附属第二医院骨科病区关节组住院治疗并由同一治疗小组行“全膝关节置换术”的94例患者(主要诊断为膝骨关节炎或者类风湿性关节炎)的临床资料。94例患者术后均放置引流管接600m1负压引流瓶,根据引流方式不同分为A、B两组,其中2014年8月1日至2015年3月1日期间行TKA手术治疗的44例患者为A组(男12例,女32例),该组患者术中释放引流瓶中负压,不予夹管,常压下引流至次日早上9点,而后用50m1针筒抽成负压(50m1针筒抽10次)继续负压引流直至拔管；2014年1月1日至2014年7月31日期间行TKA手术治疗的50例患者为B组(男18例,女32例),该组患者手术结束后使用与A组相同的负压引流瓶,术后夹闭4h后打开引流管,持续负压引流直至拔管。利用统计软件分析比较两组患者术后引流量、输血量、术后总出血量、术后住院时间、感染比例、血栓发生比例等指标,得出结论。研究结果： 1. A组术后6h常压下引流量为31.25±28.12ml,B组夹闭4h后打开引流管,术后6h计量引流瓶中引流量为83.30±69.25ml,P值0.01,差异有显著统计学意义。6-12h内B组流量(100.59±87.76ml)同样显著高于A组(29.7±51.72ml),P0.01,而在12h以后,两组12-24h (70.07±78.84ml VS67.94±49.35ml)内引流量基本一致,差异无统计学意义,P=0.96。平均拔管时间为38.70±7.23h和37.74±0.81h,P=0.59,差异无统计学意义。拔管后最终引流量B组(286.10±167.49ml)同样多于A组(171.30±112.86ml),P0.01,差异具有显著统计学意义。 2.A组的术后输血量明显少于B组,差异具有显著统计学意义(P0.01)。A组术后1天丢失的血容量同样低于B组,P值=0.01差异具有显著统计学意义。两组3天内的总失血量无统计学差别(1191±590ml VS1300±735ml,P=0.68)。两组其他指标如术后体温、术后CPM机锻炼情况、术后感染率、血栓发生率、术后住院时间等指标对比均无统计学差异。研究结论：对于行全膝关节置换术的病人来说,相比较目前广泛使用的夹闭4h后持续负压引流的方式而言,常压转负压的引流方式能有效减少术后引流量和术后总出血量,并能减少术后输血量,两组对比术后CPM机锻炼情况、术后感染率、血栓发生率、住院时间等方面无显著差别。
[Abstract]:Objectives of the study: To analyze and compare the clinical effects of two different drainage methods after total knee arthroplasty, and to provide some reference value for the choice of drainage mode after TKA. Research methods: A retrospective study of 94 cases of total knee arthroplasty performed by the same treatment group from January 1, 2014 to March 1, 2015 in the joint group of the second affiliated Hospital of Zhejiang University School of Medicine was conducted. Clinical data of osteoarthritis or rheumatoid arthritis. 94 patients were treated with drainage tube and 600m1 negative pressure drainage bottle. According to the different drainage methods, the patients were divided into two groups: group A (12 males and 32 females) treated with TKA from August 1, 2014 to March 1, 2015. Drainage under normal pressure until 9 o'clock in the next morning, and then 10 times with 50m1 syringe) continue negative pressure drainage until extubation. 50 patients undergoing TKA operation between January 1, 2014 and July 31, 2014 were in group B (18 men). 32 female patients were treated with the same negative pressure drainage bottle as group A after operation. The drainage tube was opened 4 hours after operation and continued negative pressure drainage until extubation. Statistical software was used to analyze and compare the postoperative drainage volume, blood transfusion volume, postoperative total bleeding volume, postoperative hospitalization time, infection ratio and thrombus incidence ratio between the two groups, and a conclusion was reached. Results of the study: 1. In group A, the drainage flow was 31.25 卤28.12ml / L group (31.25 卤28.12ml / L) after being clamped for 4 h, and the volume of drainage flask was 83.30 卤69.25ml / ml (P = 0.01) at 6 h after operation, which was significantly higher than that in group A (29.7 卤51.72ml / ml P 0.01) within 6-12 hours. The internal drainage flow was basically the same in the two groups (12-24 h, 70.07 卤49.35 ml), and there was no significant difference between the two groups (P < 0. 96). The mean extubation time was 38.70 卤7.23h and 37.74 卤0.81h, respectively. The final drainage volume after extubation in group B (286.10 卤167.49 ml) was also higher than that in group A (171.30 卤112.86 ml, P 0.01), and the difference was statistically significant. 2.The volume of blood transfusion in group A was significantly less than that in group B, and the difference was statistically significant. The blood volume lost in group A was also lower than that in group B (P < 0.01). There was no significant difference in total blood loss within 3 days between the two groups (1191 卤590ml VS1300 卤735ml). There was no significant difference in other indexes such as postoperative body temperature, postoperative CPM exercise, postoperative infection rate, thrombus incidence and postoperative hospitalization time between the two groups. The study concluded that: For patients undergoing total knee arthroplasty, compared with the currently widely used method of continuous negative pressure drainage after 4 hours of clamping, atmospheric pressure to negative pressure drainage can effectively reduce postoperative drainage flow and total blood loss. There was no significant difference between the two groups in terms of postoperative CPM machine exercise, postoperative infection rate, thrombus incidence, hospital stay and so on.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.4

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