氨甲环酸的三种应用方式在全膝关节置换（TKA）中的止血疗效比较和安全性分析

发布时间：2018-06-21 22:14

本文选题：氨甲环酸 + 全膝关节置换　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:将氨甲环酸的三种不同使用方式应用在全膝关节置换术中,通过对比三组术后的止血疗效和安全性,探究出氨甲环酸在全膝关节置换中的最佳应用方式。方法:采用前瞻性病例对照研究方法,通过记录患者的统计学资料、术前血液数据、术后失血量、血红蛋白值、术后并发症、输血率及发生血栓事件的概率。纳入我院2015年1月-2016年12月共124位接受单侧膝关节置换术的患者,将124位患者随机分配成3组,分别是局部组、联合组、静脉组,氨甲环酸的剂量为15mg/kg。静脉组:松开止血带之前15分钟开始静脉滴注15mg/kg剂量氨甲环酸;局部组:缝合关节腔后通过引流管逆行注射15mg/kg氨甲环酸;联合组:松止血带前15分钟开始静脉滴注15mg/kg氨甲环酸一半的剂量,并在缝合关节腔后通过引流管逆行注射15mg/kg氨甲环酸的另一半剂量。三组患者术前一般资料、凝血功能指标进行比较差异均无统计学意义(P均0.05)。比较总失血量、术后24引流量、隐性失血量、血红蛋白值、血红蛋白丢失量、VTE事件。结果:三组术后24h引流量差异无统计学差异,P0.05;联合组总失血量、隐性失血量、血红蛋白丢失量均明显低于静脉组和局部组,差异有统计学意义,P0.05;静脉组和局部组中各有4人术后出现小腿肌间静脉血栓,联合组中有2位患者术后出现小腿肌间静脉血栓,差异无统计学意义,P0.05;三组患者术后均未出现肺栓塞。结论:三组在全膝关节置换中联合组更能减少血红蛋白丢失量、总失血量及隐性失血量;三组术后三个月内VTE发生率差异无统计学意义。
[Abstract]:Objective: to explore the best application of tranexamic acid in total knee arthroplasty by comparing the hemostatic effect and safety of the three groups. Methods: a prospective case-control study was conducted to record the patient's statistical data, preoperative blood data, postoperative blood loss, hemoglobin value, postoperative complications, blood transfusion rate and probability of thrombotic events. From January 2015 to December 2016, 124 patients underwent unilateral knee arthroplasty in our hospital. 124 patients were randomly divided into three groups: local group, combined group, intravenous group, and methacylic acid (15 mg / kg). Intravenous group: 15mg/kg was injected intravenously 15 minutes before release of tourniquet, local group: 15mg/kg was injected retrograde through drainage tube after joint cavity was sutured. In the combined group, half of 15mg/kg was injected intravenously 15 minutes before the tourniquet and the other half of 15mg/kg was injected retrograde through the drainage tube after the joint cavity was sutured. There was no significant difference in preoperative general data and coagulation function between the three groups (P 0.05). Total blood loss, 24 drainage, recessive blood loss, hemoglobin value and hemoglobin loss were compared with VTE events. Results: there was no significant difference in the volume of blood loss, recessive blood loss and hemoglobin loss between the three groups 24 hours after operation (P 0.05), and the total blood loss, recessive blood loss and hemoglobin loss in the combined group were significantly lower than those in the venous group and the local group. The difference was statistically significant (P 0.05), there were 4 patients in the vein group and 4 patients in the local group, and 2 patients in the combined group developed intermuscular vein thrombosis of the leg after operation. There was no significant difference (P 0.05). No pulmonary embolism was found in the three groups. Conclusion: the combined group can reduce the amount of hemoglobin loss, total blood loss and recessive blood loss in total knee arthroplasty, but there is no significant difference in the incidence of VTE in the three groups within three months after operation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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