【作者】 曲哲；

【导师】 李宏伟；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2018， 硕士

【摘要】 目的:探讨在全膝关节置换术中限制性使用止血带联合静脉滴注氨甲环酸的相关临床效果。方法:选取2016年1月-2017年8间由吉林大学中日联谊医院骨科收治的以“膝关节骨性关节炎”为主要诊断且符合纳入标准的初次行全膝关节置换术的患者75例,并将其随机分为3组。A组:患者在截骨时使用止血带并在闭合切口前释放,且接受氨甲环酸静脉给;B组:患者全程使用止血带,且接受氨甲环酸静脉给药;C组:患者全程使用止血带,且未接受氨甲环酸给药,观察术后失血量、血红蛋白、VAS评分、膝关节活动度以及术后并发症等情况,并将数据进行统计学分析,认为P<0.05差异有统计学意义。结果:失血量方面,三组术后的血红蛋白下降值组间差异有统计学意义,其中AB组间的差异结果没有统计学意义(P>0.05),而A组与C组、B组与C组之间的差异有统计学意义;总失血量A、B两组均少于C组,组间差异有统计学意义,A、B两组之间的差异无统计学意义(P=0.806)而A组与C组之间、B组与C组之间的差异有统计学意义;术中出血量,A组与B组、A组与C组之间的差异性有统计学意义,而B组与C组之间的差异则没有统计学意义;术后引流A组小于B组小于C组,组间差异以及各组间的差异均具有统计学意义;显性失血量上B组最少,A组略小于C组,三组之间差异具有统计学意义(P值为0),其中A、B两组、B、C两组间差异认为有意义(P<0.05),而A、C两组间则无统计学差异(P=0.467);隐性失血量上则A组显著小于B组与C组,组间差异有统计学意义(P值为0),A组与B组,A组与C组差异有统计学意义,B组C组则无统计学差异;三组之间的输血率具有统计学意义。而三组患者术后第三天的VAS评分三组间比较无统计学差异,但术后第三天膝关节活动度上三组间具有统计学差异,且两组之间的分别对比也具有统计学意义(P<0.05)结论:限制性使用止血带联合静脉滴注氨甲环酸虽然会造成术中出血量的增加,但能减少术后引流量及隐性失血量,患者术后早期膝关节活动较好,有利于术后早期快速康复锻炼。更多还原

【Abstract】 Objective:To explore limiting the use of tourniquet combined with intravenous drip of tranexamic acid in the clinical effect of total knee arthroplasty Methods:A total of 75 patients who underwent the total knee arthroplasty in the Department of orthopedics,China-Japan Union Hospital of Jilin University during January 2016 to August 2017,were selected and randomly divided into 3 groups according to the inclusion criteria of “knee osteoarthritis” and the initial total knee arthroplasty in 75 cases.A group: patients in osteotomy using tourniquet and release before wound closure,and received tranexamic acid intravenous;group B: Patients with full use of tourniquet during intraoperative,and received tranexamic acid intravenous administration;group C: Patients with full use of tourniquet,but without receiving tranexamic acid administration,observe postoperative bleeding volume,hemoglobin,VAS score,range of motion and postoperative complications,and the data were analyzed statistically,there was significant difference of P < 0.05.Results:In blood loss,there was significant difference between the groups in the decreasing of postoperative hemoglobin,the difference between the group A and group B was not statistically significant(P > 0.05),between group A and group C,group B and group C,the difference was statistically significant.In the total blood loss;A and B two groups were less than in C group,there was significant difference between the groups A and B,the difference between the two groups was not statistically significant(P=0.806)and there was significant difference between A group and C group,B group and C group.The difference of intraoperative blood loss was statistically significant between A group and B group,A group and C group,but the difference between the B group and C group was not statistically significant.The differences of drainage between groups were statistically significant;the observed blood loss in group B is the least,group A is slightly less than the group C,with statistical differences between the three groups Significance(P = 0),the difference between A and B two groups,B and C between the two groups that have significance(P < 0.05),while A and C between the two groups were not statistically significant(P=0.467).However,hidden blood loss is significantly less in group A,and there was statistical significance of the differences between groups(P = 0),the blood transfusion rate between the three groups was statistically significant.There was no significant difference in the VAS score between the three groups,but there was a significant difference in the range of motion between the three groups,and the difference was also statistically significant(P < 0.05).Conclusion :Although limiting the use of tourniquet combined with intravenous drip of tranexamic acid would increase the amount of blood loss during the intraoperation,but it can reduce postoperative drainage and hidden blood loss,provide the better earl postoperative knee joint activity,is conducive to the postoperative rehabilitation.更多还原