氨甲环酸对全膝关节置换后隐性失血作用的实验研究

发布时间：2018-10-22 16:11

【摘要】：目的:通过建立人工膝关节置换动物模型,观察使用氨甲环酸后早期围手术期失血的变化,探讨氨甲环酸对隐性失血的作用以及对下肢深静脉血栓的影响。方法:自行设计完成兔膝关节假体,20只成年新西兰兔随机分成两组,每组10只,均进行同一侧膝关节置换术,实验组在术前15min给予0.5g 100ml的氨甲环酸静滴,对照组于相同时间给予100ml 0.9%的氯化钠,所有实验动物于术前一天12-14h,术后3h、6h、24h、48h、72h、第7天分别进行耳缘静脉采血,进行多次血常规及凝血功能的检查,测定血浆D-D二聚体的含量,同时记录手术时间及计算术中出血量,统一行统计学分析,术后进行下肢静脉超声检查的筛选。结果:实验组和对照组术前体重、血红蛋白、红细胞压积和D-D二聚体无明显差异(p0.05)。手术时间以及术中显性失血量的差异具有显著性意义(p0.05),术后24h的血红蛋白和红细胞压积值经比较有明显差异(p0.05),两组术后D-D二聚体没有差异性(p0.05),手术时间、术中显性失血与术后24h的血红蛋白、红细胞压积值具有明显相关性(p0.05),与术后72h、第7天的血红蛋白、红细胞压积值的变化和围手术期D-D二聚体的变化无明显相关性。术后下肢静脉超声检查无一例出现明显的血栓。结论:本文通过建立人工膝关节置换动物模型,观察使用氨甲环酸后早期围手术期失血的变化,结果显示氨甲环酸术前的使用可以明显减少术中显性失血,缩短手术时间,能够显著减少术后第一天的隐性失血量,这是由于手术应激后纤维蛋白溶解增加引起的失血进入到第三组织间隙,对非该机理引起的其他隐性失血无明显作用。同时它的安全性可靠,不增加围手术期血栓风险。本实验为氨甲环酸的临床使用提供理论依据,为探索隐性失血的机制提供帮助。
[Abstract]:Objective: to establish an artificial knee replacement animal model to observe the changes of early perioperative blood loss and to explore the effect of tranexamic acid on recessive blood loss and on deep venous thrombosis of lower extremity. Methods: a total of 20 adult New Zealand rabbits were randomly divided into two groups (10 rabbits in each group) with the same knee arthroplasty. The experimental group was given 0.5 g 15min intravenously before operation. The control group was given 0.9% sodium chloride of 100ml at the same time. All the experimental animals received blood samples from auricular vein at 12 to 14 hours before operation and from 24 hours to 48 hours after operation. On the 7th day, the blood samples were collected from the auricular vein, and the blood routine and coagulation function were examined for several times, and the plasma D-D dimer content was measured. At the same time, the time of operation and the amount of intraoperative bleeding were recorded. Results: there was no significant difference in weight, hemoglobin, hematocrit and D-D dimer between the experimental group and the control group (p0.05). The time of operation and the amount of dominant blood loss were significantly different (p0.05). The hemoglobin and hematocrit were significantly different at 24 hours after operation (p0.05). There was no difference between the two groups in D-D dimer (p0.05). There was a significant correlation between hemoglobin and hematocrit at 24 hours after operation (p0.05). There was no significant correlation with hemoglobin and hematocrit at 72 hours and 7 days after operation and the changes of D-D dimer in perioperative period. There was no obvious thrombus in lower extremity venous ultrasound after operation. Conclusion: the animal model of artificial knee arthroplasty was established to observe the changes of perioperative blood loss in the early perioperative period after the use of carbamate. The results showed that the preoperative use of carbamate could significantly reduce the apparent blood loss during operation and shorten the operation time. It can significantly reduce the amount of recessive blood loss on the first day after operation, which is due to the increase of fibrinolysis after operation and the blood loss into the third tissue space, but has no obvious effect on other recessive blood loss caused by this mechanism. At the same time, it is safe and reliable, and does not increase the perioperative risk of thrombus. This experiment provides a theoretical basis for the clinical use of methachloroic acid and helps to explore the mechanism of recessive blood loss.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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