单侧和同期双侧膝关节置换术患者围手术期安全性分析

发布时间：2018-12-12 16:39

【摘要】：目的比较单侧膝关节置换术和同期双侧膝关节置换术患者围手术期的安全性。方法回顾性分析2014年12月至2015年12月在北京协和医院行单侧或同期双侧膝关节置换术的500例患者的临床资料,分为单膝组(n=310)和双膝组(n=190),比较两组患者的一般情况、围手术期输血和并发症发生情况。结果单膝组的ASA分级(χ~2=8.344,P=0.015)和NYHA分级(χ~2=7.537,P=0.023)明显高于双膝组。双膝组术后伤口引流量明显高于单膝组(t=44.984,P=0.000),术后最低血红蛋白水平明显低于单膝组(t=0.006,P=0.000)。双膝组围手术期输血率为33.2%,明显高于单膝组的9.7%(χ~2=42.896,P=0.000)。两组患者在术后输血次数(χ~2=1.025,P=0.599)和总输血量(χ~2=3.836,P=0.429)方面差异均无统计学意义。单膝组和双膝组患者在术后住院时间(t=0.310,P=0.756)、ICU住院率(χ~2=0.317,P=0.895)及并发症发生率(χ~2=0.047,P=0.475)间差异均无统计学意义。结论对于ASA分级低、心功能好的患者,可考虑行同期双膝关节置换术。而高龄、高ASA分级、心功能差、合并症多的患者,应考虑行单侧膝关节置换术。
[Abstract]:Objective to compare the perioperative safety of unilateral knee arthroplasty and bilateral knee arthroplasty. Methods the clinical data of 500 patients undergoing unilateral or simultaneous bilateral knee arthroplasty in Peking Union Hospital from December 2014 to December 2015 were retrospectively analyzed. Perioperative blood transfusion and complications. Results the ASA grade and NYHA grade in single knee group were significantly higher than those in both knees group (蠂 ~ 2 = 8.344) and NYHA grade (蠂 ~ 2 = 7.537). The postoperative drainage volume of wound in the double knee group was significantly higher than that in the single knee group (t = 44.984), and the postoperative minimum hemoglobin level was significantly lower than that in the single knee group (t = 0.006 / P ~ (0.000). The perioperative transfusion rate in the double knee group was 33.2, which was significantly higher than that in the single knee group (9.7%) (蠂 ~ 2 = 42.896). There was no significant difference between the two groups in the number of blood transfusions (蠂 ~ 2 + 1.025) and the total blood transfusion volume (蠂 ~ (2) 3.836% P ~ (0.429). There was no significant difference in hospitalization time (t = 0.310) and complication rate (蠂 ~ 2 ~ (0.317) P ~ (0.895) between the single knee group and the double knee group (蠂 ~ (2) 0.047 P ~ (0.475). Conclusion for patients with low ASA grade and good cardiac function, simultaneous double knee arthroplasty can be considered. Patients with advanced age, high ASA grade, poor cardiac function and multiple complications should be considered for unilateral knee arthroplasty.
【作者单位】：中国医学科学院北京协和医学院北京协和医院麻醉科;中国医学科学院北京协和医学院北京协和医院骨科;
【分类号】：R687.4

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