氨甲环酸减少初次全膝关节置换术失血量的有效性和安全性评价
发布时间：2018-09-09 13:31
【摘要】：目的:观察关节腔内运用氨甲环酸注射液在骨关节炎患者行初次单膝人工关节置换术后对失血量的影响。方法:选取2014年1月~2015年3月于山西医科大学第二附属医院骨关节科接受膝关节行单侧初次骨水泥全膝关节置换术的患者为研究对象。排除标准为:目前口服或皮下注射抗凝类药物,入院后检查凝血系列提示异常的患者,伴随血液系统疾病的患者,对抗凝类药物过敏术后不能抗血栓治疗的患者;既往有血栓病史或房颤、心脏起搏器和支架植入术后的患者;术前血红蛋白低于90g/L的患者。共96例患者纳入本研究,将其随机平均分为氨甲环酸组和对照组两组,每组48例。两组术后均常规留置引流管,氨甲环酸组关节腔注射50ml氨甲环酸注射液(规格为100ml含1g氨甲环酸和0.7g氯化钠),对照组关节腔注射50ml生理盐水。两组术后都夹闭引流管3 h后放开引流。术后24小时、72小时抽取静脉血检测红细胞压积、血红蛋白、凝血酶原时间、活化部分凝血活酶时间;记录术后12小时引流量、24小时引流量、48小时引流量;计算显性失血量;检查患者术后是否有血栓形成。数据采用SPSS13.0统计软件进行统计学分析,连续型变量采用t检验,分类变量采用两独χ2检验。如果P0.05则认为差异有统计学意义。结果:1、两组患者年龄、性别、身高、体质指数、PT、APTT水平比较、术前血红蛋白、术前HCT,差异均无统计学意义(P0.05)。2、氨甲环酸组的19例(39.5%),对照组的34例(70.8%)接受了输血治疗。3、两组术后血红蛋白(Hemoglobin,HB)及红细胞压积(Hematocrit,HCT)比较,差异有统计学意义(P0.05);4、氨甲环酸组患者术后显性失血量氨甲环酸组平均为512ml,对照组平均为975ml;术后总引流量甲环酸组平均为354ml,对照组平均为805ml;12小时引流量氨甲环酸组平均为284ml,对照组平均为565ml;24小时引流量氨甲环酸组平均为60ml,对照组平均为161ml;48小时引流量氨甲环酸组平均为9ml,对照组平均为75ml。各项数值表明氨甲环酸组较对照组均减少(P0.05)。5、氨甲环酸组与对照组手术切口均I期愈合,两组经观察均无严重不良反应和并发症发生。结论:经过本实验的观察发现在使用氨甲环酸后术后的失血量及输血率有明显的降低,并且未发现严重并发症。所以初次全膝人工关节置换术后关节腔内局部应用氨甲环酸是一种操作简单、安全有效的减少术后出血的方式。
[Abstract]:Objective: to observe the effect of intraarticular methacylic acid injection on blood loss in patients with osteoarthritis after primary arthroplasty. Methods: from January 2014 to March 2015, the patients undergoing unilateral cement total knee arthroplasty in the Department of Orthopaedics and Joint of the second affiliated Hospital of Shanxi Medical University were selected as the study objects. The exclusion criteria were as follows: at present, anticoagulant drugs were injected orally or subcutaneously, patients with abnormal coagulation series were examined after admission, patients with diseases of the blood system, patients with anticoagulant allergies who could not be treated with antithrombotic therapy after operation; Patients with previous history of thrombus or atrial fibrillation, pacemaker and stent implantation; patients with preoperative hemoglobin lower than 90g/L. A total of 96 patients were randomly divided into two groups (48 cases in each group). 50ml was injected into the articular cavity of the two groups (100ml contained 1 g methocylic acid and 0.7 g sodium chloride), and the control group was injected with 50ml normal saline. The drainage tube was clamped for 3 hours after operation in both groups. Venous blood was collected 24 hours and 72 hours after operation to detect hematocrit, hemoglobin, prothrombin time and activated partial thromboplastin time. Check for thrombosis after operation. The data were analyzed by SPSS13.0 software. T test was used for continuous variables and 蠂 2 test was used for classification variables. If P0.05, the difference is statistically significant. Results: 1. Age, sex, height, body mass index (BMI) and PTT APTT were compared between the two groups. There was no significant difference in preoperative HCT, between the two groups (P0.05). There were 19 cases (39.5%) in the methacylic acid group and 34 cases (70.8%) in the control group received blood transfusion therapy. The hemoglobin (Hemoglobin,HB) and hematocrit (Hematocrit,HCT) were compared between the two groups. The difference was statistically significant (P0.05). The mean amount of dominant blood loss was 512ml in the methoxycylic acid group and 975ml in the control group, and the mean flow rate was 354ml in the total drainage group and 805ml / 12h in the control group. The average flow rate of the control group was 565 ml / 24 h, the mean flow rate of the control group was 60 ml / 24 hours, the mean value of the control group was 161ml / 48 h, the mean value of the control group was 9 ml and the control group's average was 75 ml / min. All the values showed that the number of methacylic acid group was lower than that of the control group (P0.05). The operation incision of the two groups were healed in the first stage, and no serious adverse reactions and complications occurred in the two groups. Conclusion: the blood loss and blood transfusion rate were significantly decreased and no serious complications were found. Therefore, local intraarticular application of carbamoic acid is a simple, safe and effective way to reduce postoperative bleeding after primary total knee arthroplasty.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
[Abstract]:Objective: to observe the effect of intraarticular methacylic acid injection on blood loss in patients with osteoarthritis after primary arthroplasty. Methods: from January 2014 to March 2015, the patients undergoing unilateral cement total knee arthroplasty in the Department of Orthopaedics and Joint of the second affiliated Hospital of Shanxi Medical University were selected as the study objects. The exclusion criteria were as follows: at present, anticoagulant drugs were injected orally or subcutaneously, patients with abnormal coagulation series were examined after admission, patients with diseases of the blood system, patients with anticoagulant allergies who could not be treated with antithrombotic therapy after operation; Patients with previous history of thrombus or atrial fibrillation, pacemaker and stent implantation; patients with preoperative hemoglobin lower than 90g/L. A total of 96 patients were randomly divided into two groups (48 cases in each group). 50ml was injected into the articular cavity of the two groups (100ml contained 1 g methocylic acid and 0.7 g sodium chloride), and the control group was injected with 50ml normal saline. The drainage tube was clamped for 3 hours after operation in both groups. Venous blood was collected 24 hours and 72 hours after operation to detect hematocrit, hemoglobin, prothrombin time and activated partial thromboplastin time. Check for thrombosis after operation. The data were analyzed by SPSS13.0 software. T test was used for continuous variables and 蠂 2 test was used for classification variables. If P0.05, the difference is statistically significant. Results: 1. Age, sex, height, body mass index (BMI) and PTT APTT were compared between the two groups. There was no significant difference in preoperative HCT, between the two groups (P0.05). There were 19 cases (39.5%) in the methacylic acid group and 34 cases (70.8%) in the control group received blood transfusion therapy. The hemoglobin (Hemoglobin,HB) and hematocrit (Hematocrit,HCT) were compared between the two groups. The difference was statistically significant (P0.05). The mean amount of dominant blood loss was 512ml in the methoxycylic acid group and 975ml in the control group, and the mean flow rate was 354ml in the total drainage group and 805ml / 12h in the control group. The average flow rate of the control group was 565 ml / 24 h, the mean flow rate of the control group was 60 ml / 24 hours, the mean value of the control group was 161ml / 48 h, the mean value of the control group was 9 ml and the control group's average was 75 ml / min. All the values showed that the number of methacylic acid group was lower than that of the control group (P0.05). The operation incision of the two groups were healed in the first stage, and no serious adverse reactions and complications occurred in the two groups. Conclusion: the blood loss and blood transfusion rate were significantly decreased and no serious complications were found. Therefore, local intraarticular application of carbamoic acid is a simple, safe and effective way to reduce postoperative bleeding after primary total knee arthroplasty.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
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