围手术期多次和单次使用氨甲环酸在全膝关节置换术中的有效性和安全性分析

发布时间：2018-08-23 21:31

【摘要】：目的:比较在全膝关节置换围术期多次使用氨甲环酸较单次使用氨甲环酸的有效性和安全性。方法:回顾性收集我院2016年8月到2016年12月期间行初次单侧全膝关节置换的病人的临床数据。我科在2016年8月到2016年10月期间,手术前30min单次静脉滴注氨甲环酸1.5g;2016年11月到2016年12月期间,为进一步减少患者术中、术后失血,将单次使用氨甲环酸改为多次使用:分别为术前30min1.5g静脉滴注,术中关闭手术切口前1g局部注射,手术结束后3h,12h,24h,48h,72h各1g静脉滴注。比较两个阶段病人的总失血量,术后不同时间血红蛋白、输血患者比例、凝血象、深静脉血栓和肺栓塞等栓塞性事件的发生率,以及C反应蛋白,血沉等炎症指标。结果:和先前的单次使用氨甲环酸相比,总失血量:多次使用组患者为(499.56±244.2m1),单次使用组患者为(764.47±311.35m1),(P0.001);隐性失血量:多次使用组为(309.65±42.67 m1),单次使用组为(480.23±46.28 m1),(P0.001);术后引流量:多次使用组为(46.87±12.31m1),单次使用组为(135.64±95.32m1),(P0.001);术后血红蛋白下降最大值:多次使用组为(15.67±8.94 g/L),单次使用组为(26.64±11.04 g/L)(P0.001);上述比较可见多次使用组均较单次使用组低,且有统计学差异。而关于凝血象、输血率、深静脉血栓和肺栓塞的发生率,单次使用与多次使用组之间未见明显差异。和单次使用氨甲环酸组相比,多次使用氨甲环酸的患者的C反应蛋白,血沉在术后的第1、3、5 d均低于单次使用患者。结论:在全膝关节置换术中,与单次使用氨甲环酸相比,多次使用氨甲环酸有助于进一步有效降低患者的总失血量,减少患者术后第1、3、5 d的血红蛋白的丢失,持续降低患者术后的炎症反应强度,同时不增加血栓形成风险。
[Abstract]:Objective: to compare the efficacy and safety of multiple use of methachlorocylic acid in perioperative period of total knee arthroplasty. Methods: the clinical data of patients undergoing first unilateral total knee arthroplasty from August 2016 to December 2016 were collected retrospectively. During the period from August 2016 to October 2016, 30min was given a single intravenous drip of 1.5 g of carbamoic acid between August 2016 and October 2016. From November 2016 to December 2016, in order to further reduce the blood loss during and after operation, The single use of carbamoic acid was changed into multiple use: preoperative 30min1.5g intravenous drip, 1 g local injection before closing the surgical incision during the operation, and 1 g intravenous drip 3 h after operation at 12 h, 24 h, 48 h and 72 h, respectively. The total blood loss, hemoglobin at different time after operation, the proportion of blood transfusion patients, the incidence of thromboembolism, deep vein thrombosis and pulmonary embolism, and inflammatory indexes such as C-reactive protein and erythrocyte sedimentation were compared between the two stages. Results: compared with previous single use of carbamate, Total blood loss: multiple use group (499.56 卤244.2m1), single use group (764.47 卤311.35m1), (P0.001), occult blood loss: multiple use group (309.65 卤42.67ml), single use group (480.23 卤46.28ml), (P0.001), postoperative drainage volume: multiple use group (46.87 卤12.31m1), single use group (135.64 卤95.32m1), (P0.001), postoperative blood loss volume: multiple use group (46.87 卤12.31m1), single use group (135.64 卤95.32m1), (P0.001), postoperative blood loss volume (309.65 卤42.67m-1), postoperative drainage volume: multiple use group (46.87 卤12.31m1), single use group (135.64 卤95.32m1), (P0.001); The maximum white drop was (15.67 卤8.94 g / L) in multiple use group and (26.64 卤11.04 g / L) in single use group (P0.001). And there is statistical difference. There was no significant difference in coagulation, blood transfusion rate, deep venous thrombosis and pulmonary embolism between single and multiple use groups. Compared with the single group, the erythrocyte sedimentation rate (ESR) of the patients with multiple use of carbamate was significantly lower than that of the patients who were given monocycline on the 1st day after operation. Conclusion: in total knee arthroplasty, compared with single use of carbonic acid, repeated use of carbamoic acid can further reduce the total blood loss and hemoglobin loss of the patients at the 3rd day after operation. Sustained reduction of postoperative inflammatory response without increased risk of thrombosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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