关节囊周围注射氨甲环酸对初次单侧髋关节置换术后失血量和关节功能的影响

发布时间：2018-09-08 21:24

【摘要】：背景:氨甲环酸能够明显减少髋、膝关节置换术围手术期失血,但氨甲环酸的给药方式存在诸多争议。目的:探讨初次单侧髋关节置换术后关节囊周围注射氨甲环酸对失血量和关节功能的有效性和安全性。方法:应用回顾性研究方法对冀中能源峰峰集团邯郸院区2013年1月至2016年1月选取股骨头坏死合并髋关节骨性关节炎行初次单侧全髋关节置换术的243例患者,男性131例,女性112例,年龄55~70岁平均年龄(62.2±4.1)岁。86例术中缝合前关节囊周围注射1g氨甲环酸(氨甲环酸注射组),82例于手术切口前20分钟静点1g氨甲环酸生理盐水50ml(氨甲环酸静滴组),75例未使用氨甲环酸(无药物干预组)。记录三组患者术中失血量、术中输血量、术中输血率、手术时间和术后24小时引流量、术后输血量、术后输血率、术后血栓形成情况、术后髋关节Harris评分,计算三组患者总失血量和隐性失血量。结果:所有患者均顺利完成手术,围手术期未发生切口感染、不愈合、脂肪液化坏死等手术并发症,无氨甲环酸副作用出现。三组病例性别、年龄、体重指数、病程、侧别、手术时间、术前血容量、术中失血量、术中输血率无统计学意义(P0.05)。术后输血量:氨甲环酸注射组、氨甲环酸静滴组、无药物干预组比较有统计学差异(P0.05);其中氨甲环酸注射组与氨甲环酸静滴组比较无统计学差异(P0.05)。术后输血率:氨甲环酸注射组、氨甲环酸静滴组、无药物干预组比较有统计学差异(P0.05);其中氨甲环酸注射组与氨甲环酸静滴组比较无统计学差异(P0.05)。术后隐性失血量:氨甲环酸注射组、氨甲环酸静滴组、无药物干预组比较有统计学差异(P0.05);其中氨甲环酸注射组与氨甲环酸静滴组比较无统计学差异(P0.05)。术后引流量:氨甲环酸注射组、氨甲环酸静滴组、无药物干预组比较有统计学差异(P0.05);其中氨甲环酸注射组与氨甲环酸静滴组比较无统计学差异(P0.05)。总失血量:氨甲环酸注射组、氨甲环酸静滴组、无药物干预组比较有统计学差异(P0.05);其中氨甲环酸注射组与氨甲环酸静滴组比较无统计学差异(P0.05)。氨甲环酸注射组、氨甲环酸静滴组、无药物干预组术后髋关节Harris评分比较无统计学差异(P0.05)。结论:全髋关节置换术中关节囊周围注射和静滴氨甲环酸均可减少术后失血量、术后输血量、降低术后输血率,未增加患肢静脉血栓风险。两种给药方式对术后输血量、术后失血量、术后输血率无明显差别。关节囊周围注射氨甲环酸对术后髋关节功能无影响。
[Abstract]:Background: tranexamic acid can significantly reduce perioperative blood loss in hip and knee arthroplasty. Objective: to investigate the efficacy and safety of peri-capsular injection of aminoformic acid on blood loss and joint function after primary unilateral hip arthroplasty. Methods: from January 2013 to January 2016, 243 patients (131 males) with osteonecrosis of femoral head and osteoarthritis of hip joint underwent the first unilateral total hip arthroplasty in Handan Hospital of Jizhong Energy Fengfeng Group. 112 women, The mean age of 5570 years was (62.2 卤4.1) years old. 86 patients with intraoperative injection of 1 g methocylic acid around the articular capsule (methocycline injection group) and 82 patients with intraoperative intraarticular capsule injection of 1 g 50ml (intraoperative intraarticular injection group) without intraoperative injection of methachlorocylic acid (50ml) were performed 20 minutes before the incision. Use carbamicylic acid (no drug intervention group). The blood loss, blood transfusion rate, operation time, 24 hours drainage rate, blood transfusion rate, postoperative thrombus formation, postoperative hip joint Harris score were recorded in the three groups. Total blood loss and hidden blood loss were calculated in the three groups. Results: all the patients completed the operation successfully. No incision infection, nonunion, fat liquefaction and necrosis were found in perioperative period. Gender, age, body mass index, course of disease, side, operation time, preoperative blood volume, intraoperative blood loss and blood transfusion rate were not statistically significant in the three groups (P0.05). The amount of blood transfusion after operation: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocycline injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). Postoperative blood transfusion rate: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocycline injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). The amount of recessive blood loss was significantly different between the two groups (P0.05), and there was no significant difference between the two groups (P0.05). Postoperative drainage: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocyclic acid injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). Total blood loss: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocyclic acid injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). There was no significant difference in Harris score of hip joint between the two groups (P0.05). Conclusion: periarticular injection and intravenous drip of carbamoic acid in total hip arthroplasty can reduce postoperative blood loss, blood transfusion volume and blood transfusion rate, but do not increase the risk of venous thrombosis in the affected limbs. There was no significant difference in blood transfusion, blood loss and blood transfusion rate between the two methods. The postoperative hip function was not affected by intra-articular injection of carbamoic acid.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】