多模式方案对减少单膝关节置换围手术期失血及术后膝关节功能的影响
发布时间：2019-06-09 12:29
【摘要】：目的:为达到降低单侧全膝关节置换术(total knee arthroplasty,TKA)围手术期失血量、减低术后输血率而采用的多模式方案的有效及安全性的探讨研究。方法:将于2013年1月~4月我科行单侧全膝关节置换的98例符合标准的患者随机分为采用多模式方案减少围手术期失血的49名患者为A组,未采用该方案的49名患者为B组,术前所有患者均完善血常规、凝血像、双下肢静脉彩超等检查。多模式止血方案包括:术前血红蛋白浓度的优化,静脉用氨甲环酸,鸡尾酒混合剂术中关节内外的运用,术中关节内局部用氨甲环酸并且引流管夹闭3h,术后48h内手术切口外冰敷及患肢髋关节和膝关节屈曲抬高等方案。两组患者在性别组成、体重指数(body mass index,BMI)等术前基线资料比较无统计学意义。记录所有患者术中出血量等数据并于术后复查血常规记录血红蛋白(Hb)、红细胞压积(Hct)的具体数值,当术后Hb80g/L时或有明显贫血症状给予输血,根据公式计算术后隐性失血量、显性失血量等指标;测量术后第1、2、4周膝关节髌骨上、下极相距10厘米及髌骨上极处周径作为评估肿胀指标及术后6、24、48、72h用VAS疼痛评分标准评价术后膝关节疼痛情况,用匹兹堡睡眠质量指数(Pittsburg sleep quality index,PSQI)作为所有患者围手术期睡眠质量的评估标准。术后7、14天及第1、6、12、18月以KSS评分标准评估膝关节功能情况和膝关节活动度并记录,同时观察患者术后深静脉血栓形成等严重并发症情况,术后怀疑下肢深静脉血栓者行下肢深静脉B超排除。结果:两组患者术前资料具有可比性,A组患者术后引流量、围手术期总失血量等指标均显著低于B组,A组术后第1天、3天患者Hb和Hct的降低值小于B组患者(P0.05);术后输血A组0例,B组10例(27.77%),B组平均输红细胞111.11ml,两组相比输血率差异有统计学意义(P0.05);除术后第一天夜间睡眠质量两组间无差异(P0.05),余A组睡眠质量均优于B组(P0.05);术后A组患肢肿胀较B组患者改善(P0.05);术后6h的VAS评分无统计学意义(P0.05),但术后24、48、72h的VAS评分A组较B组明显减少(P0.05);术后第7、14、30天的KSS评分和膝关节活动度A组均优于B组(P0.05),但是术后6、12、18月的KSS评分两组无明显差异(P0.05)。随访18个月,A组与B组患者均未发现深静脉血栓及相关并发症。结论:多模式方案对减少单膝TKA术后血液丢失效果显著甚至达到零输血率的目标,可以减轻TKA术后早期患肢肿胀情况缓解术后早期疼痛改善患者术后睡眠质量,并促进TKA患者早期KSS评分和膝关节功能的恢复,同时并不增加相关并发症的发生,该多模式方案安全、有效、经济、简单。
[Abstract]:Objective: to study the effectiveness and safety of multimode regimen to reduce perioperative blood loss and postoperative transfusion rate in unilateral total knee arthroplasty (total knee arthroplasty,TKA). Methods: from January to April 2013, 98 patients who met the standard of unilateral total knee arthroplasty were randomly divided into group A (49 patients with multi-mode regimen to reduce perioperative blood loss) and group B (49 patients without this regimen). Before operation, all patients improved blood routine, coagulation image, lower extremity vein color Doppler ultrasound and so on. The multimode hemostatic scheme included the optimization of hemoglobin concentration before operation, the internal and external use of carbamecarboxylic acid and cocktail mixture during operation, the local use of carbamate in the joint during the operation and the clamping of the drainage tube for 3 hours. Within 48 hours after operation, the external ice compress of the incision and the flexion and elevation of the hip joint and knee joint of the affected limb were performed. There was no significant difference in preoperative baseline data such as sex composition and body mass index (body mass index,BMI) between the two groups. The intraoperative blood loss and other data of all patients were recorded and the specific values of hemoglobin (Hb), hematocrit (Hct) were recorded by blood routine review after operation. When Hb80g/L was performed after operation, blood transfusion was given with obvious anemia symptoms. According to the formula, the hidden blood loss and dominant blood loss after operation were calculated. The distance between the upper and lower poles of the patella and the circumference of the upper pole of the patella were measured at the 1st, 2nd and 4th week after operation as the index of swelling and the pain of the knee joint was evaluated by VAS pain score at 72 h after operation. Pittsburgh sleep quality index (Pittsburg sleep quality index,PSQI) was used as the evaluation standard of perioperative sleep quality in all patients. The function of knee joint and the range of motion of knee joint were evaluated and recorded by KSS score standard at 7, 14 days and 1,6 months after operation, and the serious complications such as deep venous thrombosis were observed at the same time. Patients with suspected deep venous thrombosis of lower extremity were excluded by B-ultrasound. Results: the preoperative data of the two groups were comparable. The postoperative drainage volume and the total blood loss in group A were significantly lower than those in group B. the decrease of Hb and Hct in group A was lower than that in group B on the 1st and 3rd day after operation (P 0.05). There were 0 cases in group A and 10 cases in group B (27.77%), B group). There was significant difference in the transfusion rate between the two groups (P 0.05). Except that there was no difference in sleep quality between the two groups on the first day after operation (P 0.05), the sleep quality in group A was better than that in group B (P 0.05), and the swelling of affected limbs in group A was better than that in group B (P 0.05). There was no significant difference in VAS score at 6 h after operation (P 0.05), but the VAS score in group A was significantly lower than that in group B at 24 h, 48 h and 72 h after operation (P 0.05). On the 7th, 14th and 30th day after operation, the KSS score and knee motion in group A were better than those in group B (P 0.05), but there was no significant difference in KSS score between the two groups at 6 months, 12 months and 18 months after operation (P 0.05). Follow-up for 18 months showed no deep venous thrombosis and related complications in group A and group B. Conclusion: the multimode regimen has a significant effect on reducing blood loss after one knee TKA and even achieves the goal of zero blood transfusion rate, which can reduce the swelling of affected limbs in the early stage after TKA, relieve the early pain after operation, and improve the sleep quality of patients after operation. It also promotes the recovery of early KSS score and knee joint function in patients with TKA, and does not increase the occurrence of related complications. The multi-mode regimen is safe, effective, economical and simple.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
本文编号：2495557
[Abstract]:Objective: to study the effectiveness and safety of multimode regimen to reduce perioperative blood loss and postoperative transfusion rate in unilateral total knee arthroplasty (total knee arthroplasty,TKA). Methods: from January to April 2013, 98 patients who met the standard of unilateral total knee arthroplasty were randomly divided into group A (49 patients with multi-mode regimen to reduce perioperative blood loss) and group B (49 patients without this regimen). Before operation, all patients improved blood routine, coagulation image, lower extremity vein color Doppler ultrasound and so on. The multimode hemostatic scheme included the optimization of hemoglobin concentration before operation, the internal and external use of carbamecarboxylic acid and cocktail mixture during operation, the local use of carbamate in the joint during the operation and the clamping of the drainage tube for 3 hours. Within 48 hours after operation, the external ice compress of the incision and the flexion and elevation of the hip joint and knee joint of the affected limb were performed. There was no significant difference in preoperative baseline data such as sex composition and body mass index (body mass index,BMI) between the two groups. The intraoperative blood loss and other data of all patients were recorded and the specific values of hemoglobin (Hb), hematocrit (Hct) were recorded by blood routine review after operation. When Hb80g/L was performed after operation, blood transfusion was given with obvious anemia symptoms. According to the formula, the hidden blood loss and dominant blood loss after operation were calculated. The distance between the upper and lower poles of the patella and the circumference of the upper pole of the patella were measured at the 1st, 2nd and 4th week after operation as the index of swelling and the pain of the knee joint was evaluated by VAS pain score at 72 h after operation. Pittsburgh sleep quality index (Pittsburg sleep quality index,PSQI) was used as the evaluation standard of perioperative sleep quality in all patients. The function of knee joint and the range of motion of knee joint were evaluated and recorded by KSS score standard at 7, 14 days and 1,6 months after operation, and the serious complications such as deep venous thrombosis were observed at the same time. Patients with suspected deep venous thrombosis of lower extremity were excluded by B-ultrasound. Results: the preoperative data of the two groups were comparable. The postoperative drainage volume and the total blood loss in group A were significantly lower than those in group B. the decrease of Hb and Hct in group A was lower than that in group B on the 1st and 3rd day after operation (P 0.05). There were 0 cases in group A and 10 cases in group B (27.77%), B group). There was significant difference in the transfusion rate between the two groups (P 0.05). Except that there was no difference in sleep quality between the two groups on the first day after operation (P 0.05), the sleep quality in group A was better than that in group B (P 0.05), and the swelling of affected limbs in group A was better than that in group B (P 0.05). There was no significant difference in VAS score at 6 h after operation (P 0.05), but the VAS score in group A was significantly lower than that in group B at 24 h, 48 h and 72 h after operation (P 0.05). On the 7th, 14th and 30th day after operation, the KSS score and knee motion in group A were better than those in group B (P 0.05), but there was no significant difference in KSS score between the two groups at 6 months, 12 months and 18 months after operation (P 0.05). Follow-up for 18 months showed no deep venous thrombosis and related complications in group A and group B. Conclusion: the multimode regimen has a significant effect on reducing blood loss after one knee TKA and even achieves the goal of zero blood transfusion rate, which can reduce the swelling of affected limbs in the early stage after TKA, relieve the early pain after operation, and improve the sleep quality of patients after operation. It also promotes the recovery of early KSS score and knee joint function in patients with TKA, and does not increase the occurrence of related complications. The multi-mode regimen is safe, effective, economical and simple.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
【参考文献】
相关期刊论文 前1条
1 彭辉煌;吴建伟;邱海胜;;全膝关节置换术后出血的影响因素及预防[J];国际骨科学杂志;2009年03期
，本文编号：2495557
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