本文選題：氨甲環(huán)酸　切入點：雙側膝關節(jié)置換術　出處：《暨南大學》2015年碩士論文

【摘要】：目的比較同期雙側膝關節(jié)表面置換不同時間點靜滴氨甲環(huán)酸對圍手術期出血及術后靜脈血栓栓塞發(fā)生率的影響。方法1、回顧性分析2012年9月至2014年12月間初次行雙膝關節(jié)置換患者32例,按照之前用藥方案分四組;2、用藥方案分組:A組(11例)在手術開始前30分鐘及手術結束縫合術口前30分鐘靜脈使用氨甲環(huán)酸;B組(7例)在手術開始前30分鐘靜滴氨甲環(huán)酸;C組(8例)手術結束縫合術口前30分鐘靜滴氨甲環(huán)酸(單次劑量均為15mg/kg);D組(6例)為不使用氨甲環(huán)酸;3、記錄各組術后24小時引流量及總引流量,術后輸血率,術后24小時、72小時及1周的血紅蛋白值;4、檢測術后24h凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)、纖維蛋白原(FIB)和D-二聚體,術后24小時、3天、1周的疼痛VAS評分及術后3d患膝被動活動度,靜脈血栓栓塞(VTE)發(fā)生率。結果1、A、B、C組的術后24h的平均引流量、總引流量、輸血率分別少于D組,其中A組最少(P0.05)。2、A組術后24h、72h的Hb值明顯高于B、C、D組(P0.05)。D組術后D-二聚體明顯高于A、B、C組(P0.05),A、B、C組間比較差異無統(tǒng)計學意義(P0.05);3、A組術后24h疼痛VAS評分明顯低于B、C、D組(P0.05);術后輸血率A組2人(18%)、B組3人(43%)、C組3人(37%)、D組3人(50%)。術后24h的PT、APTT、FIB、術后3d患膝主被動活動度四組間比較無統(tǒng)計學意義(P0.05)。4、四組患者均未出現(xiàn)VTE臨床癥狀,術后2周彩超檢測下肢動靜脈未見血栓形成。結論1、氨甲環(huán)酸在減少同期雙膝關節(jié)表面置換術后圍手術期失血和輸血率的同時,并不增加VTE的發(fā)生率和影響術膝術后早期功能鍛煉。2、其中術前30min與關閉切口前30min靜滴氨甲環(huán)酸這種方法效果較佳,值得推廣應用。
[Abstract]:Objective to compare the effects of intravenously instilled methionine on the incidence of perioperative hemorrhage and postoperative venous thromboembolism in patients with bilateral knee joint surface replacement at different time points. Methods 1. The first time between September 2012 and December 2014 was analyzed retrospectively. 32 patients with double knee arthroplasty, According to the previous regimen, 7 patients in group B received intravenously ammonia 30 minutes before the operation and 30 minutes before the end of the operation.) 30 minutes before the operation began, 7 patients in group B received intravenous drip of ammonia. Group C (n = 8) were treated with intravenously dripping methacylic acid 30 minutes before the end of suture (6 cases in group D with a single dose of 15 mg / kg). The drainage volume and total drainage flow were recorded 24 hours after operation in each group. The blood transfusion rate, the hemoglobin values of 24 hours, 72 hours and 1 week after operation were measured. The prothrombin time (PTT), activated partial thromboplastin time (APTT), fibrinogen fibrinogen (FIBF) and D-dimer (Ddimer) were measured. The VAS score of pain and the incidence of passive knee motion and venous thromboembolism (VTE) were measured at 24 hours and 3 days after operation. Results 1 the mean drainage flow, total drainage volume and blood transfusion rate in group C were lower than those in group D, respectively. The HB value in group A was significantly higher than that in group A at 24 hours after operation, and that in group D was significantly higher than that in group A (P 0.05). There was no significant difference between group A and group A (P 0.053A, P 0.053A), and the postoperative blood transfusion rate (A) was significantly lower than that in group B (P 0.053A), and the postoperative blood transfusion rate (A) was significantly higher than that in group A (P 0.05), and the postoperative blood transfusion rate (A) was significantly higher than that in group A (P 0.053A), and the postoperative blood transfusion rate (A) was significantly higher than that in group A (P 0.05). Group B (n = 3) and group C (n = 3), group D (n = 3) and group D (n = 3). There was no significant difference in the active and passive activity of the knee between the four groups on the 3rd day after operation (P 0.05). No clinical symptoms of VTE were found in all the four groups. Conclusion: 1. The rate of blood loss and blood transfusion during the perioperative period after double knee joint surface replacement was decreased. The incidence of VTE was not increased and the early functional exercise of knee was not affected. Among them, 30min before operation and 30min before closure of incision had better effect, which was worth popularizing.
【學位授予單位】：暨南大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4

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1 郇松瑋;姚平;劉寧;李R既，

本文編號：1661010