引流管夹闭联合冰桶冷疗对全髋关节置换术后失血量的影响

发布时间：2018-12-16 05:03

【摘要】：目的:探讨术后早期引流管夹闭联合冰桶冷疗这种简单易行的综合措施减少全髋关节置换术后失血量的有效性。方法:随机选取2015年9月~2016年10月在吉林大学第二医院骨科医学中心行初次全髋关节置换术患者60例,随机分为三组,对照组(术后未夹闭引流管未使用冰桶冷疗)、冷疗组(术后未夹闭引流管术后局部冰桶24小时持续冷疗)、综合组(术后早期夹闭引流管4小时联合局部冰桶24小时持续冷疗),每组各20例,对照组患者共20例,男性10例,女性10例,股骨颈骨折8例,股骨头坏死12例,患肢右侧13例,左侧7例,平均年龄为62.80岁,平均体重为65.85kg,平均体重指数为23.92;冷疗组患者共20例,其中男性10例,女性10例,股骨颈骨折6例,股骨头坏死14例,患肢右侧12例,左侧8例,平均身高为1.62m,平均体重为69.05 kg,平均体重指数为26.24;综合组患者共20例,男性7例,女性13例,股骨颈骨折7例,股骨头坏死13例,患肢右侧7例,左侧13例,平均年龄为63.05岁,平均体重为61.25kg,平均体重指数为23.61,记录并探究在术后失血量、引流量、隐性失血量、术后并发症等方面的差异,对早期引流管夹闭联合冷疗对初次全髋关节置换术后失血量的影响及近期安全性进行研究。结果:1.冷疗组与对照组相比,总失血量减少(P0.05),隐性失血量减少(P0.05),引流量没有明显变化(P0.05),切口并发症无统计学差异。2.早期引流管夹闭联合冷疗综合组与冷疗组相比,总失血量减少(P0.05),引流量(P0.05)减少,隐性失血量没有明显变化(P0.05),切口并发症无统计学差异。结论:初次全髋关节置换术后,24小时持续冰桶冷疗可以减少术后隐性失血,减少总失血量,在此基础上联合早期引流管夹闭可以减少术后显性失血,同时没有增加术后隐性失血,进一步减少总失血量,并且没有增加术后血肿、感染、切口不愈合及深静脉血栓的发生率。初次全髋关节置换术后采用早期引流管夹闭联合冷疗综合措施可以更有效地减少术后失血,简单易行,有一定临床指导意义。
[Abstract]:Objective: to investigate the effectiveness of early drainage tube clamping combined with ice bucket cold therapy in reducing blood loss after total hip arthroplasty. Methods: from September 2015 to October 2016, 60 patients with primary total hip arthroplasty were randomly divided into three groups: the control group (the control group was not treated with ice bucket after operation), and the total hip replacement was performed in the orthopedic center of the second Hospital of Jilin University from September 2015 to October 2016. There were 20 cases in each group (20 cases in each group), 20 cases in each group, 20 cases in each group, and 20 cases in the control group (4 hours after early clamping of drainage tube and 24 hours of continuous cold therapy in local ice bucket). Male 10 cases, female 10 cases, femoral neck fracture 8 cases, femoral head necrosis 12 cases, right side 13 cases, left 7 cases, mean age 62.80 years, average body weight 65.85 kg, average body mass index 23.92; There were 20 patients in the cold therapy group, including 10 males, 10 females, 6 femoral neck fractures, 14 femoral head necrosis, 12 right limbs and 8 left limbs, with an average height of 1.62m and an average weight of 69.05 kg,. The average body mass index was 26.24; In the combined group, there were 20 patients, male 7, female 13, femoral neck fracture 7, femoral head necrosis 13, right extremity 7, left 13, mean age 63.05 years, average body weight 61.25 kg, average body mass index 23.61, average age 63.05 years, average body weight 61.25 kg, average body mass index 23.61, average age 63.05 years, average body weight 61.25 kg, average body mass index 23.61. To record and explore the differences in postoperative blood loss, drainage volume, recessive blood loss, postoperative complications and so on. The effect of early drainage tube clipping combined with cold therapy on blood loss after primary total hip arthroplasty and its short-term safety were studied. Results: 1. Compared with the control group, total blood loss decreased (P0.05), recessive blood loss decreased (P0.05), drainage flow did not change (P0.05), incision complications had no statistical difference. 2. Compared with the cold therapy group, the total blood loss decreased (P0.05), the drainage flow (P0.05) decreased, the recessive blood loss did not change significantly (P0.05), the incision complications were not significantly different in the early drainage tube clipping combined with cold therapy group. Conclusion: after the initial total hip arthroplasty, 24 hours continuous cold therapy with ice bucket can reduce the recessive blood loss and decrease the total blood loss. On this basis, combined with early drainage tube clipping can reduce the visible blood loss after operation. At the same time, there was no increase in recessive blood loss, further reduction of total blood loss, and no increase in the incidence of postoperative hematoma, infection, incision nonunion and deep venous thrombosis. The application of early drainage tube clamping combined with cold therapy after primary total hip arthroplasty can reduce postoperative blood loss more effectively. It is simple and feasible and has certain clinical significance.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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