本文選題：氨甲環(huán)酸　切入點：髖　出處：《浙江大學》2015年碩士論文

【摘要】：目的 比較氨甲環(huán)酸(tranexamic acid, TXA)的不同用法在減少單側初次全髖關節(jié)置換術(total hip arthroplasty, THA)術后出血的療效及安全性。 方法 回顧性分析2014年1月至2015年2月符合入選要求的97例行單側初次全髖關節(jié)置換術的患者資料。其中男52例,女45例,根據(jù)術中氨甲環(huán)酸的使用方法不同分為三組。A組35例：不用氨甲環(huán)酸；B組32例：縫合關節(jié)腔后給予關節(jié)腔內(nèi)注射30mg/kg的氨甲環(huán)酸；C組30例：切皮前予15mg/kg的氨甲環(huán)酸靜脈滴注,縫合關節(jié)腔后給予關節(jié)腔內(nèi)注射3Omg/kg的氨甲環(huán)酸。統(tǒng)計各組患者的性別,年齡,體重指數(shù)(body mass index, BMI),術前血紅蛋白(hemoglobin, Hb),紅細胞壓積(hematocrit, HCT)以及術中失血量、術后48h引流量、輸血率、術后血紅蛋白、紅細胞壓積及手術前后血紅蛋白、紅細胞壓積差值等評價指標,并觀察患者術后是否出現(xiàn)下肢深靜脈血栓形成(deep venous thrombosis, DVT)及肺栓塞(pulmonary embolism, P E)的臨床癥狀,并針對性地進行下肢血管多普勒超聲及肺動脈血管成像(computed tomography angiography, CTA)檢查。結果 術前三組患者性別,年齡,體重指數(shù),術前血紅蛋白,紅細胞壓積指標比較差異無統(tǒng)計學意義(P/χ2＞0.05),術中失血量、術后DVT/P E及肺炎、切口感染等并發(fā)癥發(fā)生率三組比較差異無統(tǒng)計學意義(P/χ2＞0.05),但術后48h引流量、輸血率A組大于B組和C組(P0.05),B組和C組在輸血率、術后Hb及HCT方面無明顯差異(P0.05),但是值得注意的是手術前后血紅蛋白和紅細胞壓積下降幅度B組大于C組(P0.05)。 結論 局部應用氨甲環(huán)酸能明顯降低全髖關節(jié)置換術患者的術后失血量及輸血率,局部聯(lián)合靜脈應用止血效果更好,并且不增加靜脈血栓形成的風險。
[Abstract]:Purpose. To compare the efficacy and safety of different use of tranexamic acid (TXA) in reducing bleeding after unilateral total hip arthroplasty (tha). Method. The data of 97 patients undergoing unilateral primary total hip arthroplasty from January 2014 to February 2015 were analyzed retrospectively, including 52 males and 45 females. According to the different methods used in operation, the patients were divided into three groups: group A (n = 35): group B (n = 32), group B (n = 32): group C (n = 30) treated with intraarticular injection of 30mg/kg after suture of articular cavity, and group C (n = 30) received 15mg/kg intravenously before skin incision. Patients in each group were given intraarticular injection of 3Omg/kg after suture. Sex, age, body mass index (BMI), body mass index (BMI), preoperative hemoglobin hemoglobulin (HB), hematocrit (HCT), hematocrit (HCT), blood loss during operation, drainage flow at 48 hours after operation, and blood transfusion rate were counted. Hemoglobin, hematocrit, difference of hemoglobin and hematocrit before and after operation were evaluated. The clinical symptoms of deep venous thrombus (DVTs) and pulmonary embolism (Pe) were observed. The lower extremity vascular Doppler ultrasound and pulmonary artery angiography were performed by computed tomography angiography (CTA). There was no significant difference in sex, age, body mass index, preoperative hemoglobin and hematocrit in the three groups before operation (P / 蠂 2 > 0.05). Blood loss, postoperative DVT/P E and pneumonia were not significant in the three groups. There was no significant difference in the incidence of incision infection and other complications among the three groups, but the blood transfusion rate in group A was higher than that in group B and group C at 48 h after operation, and the blood transfusion rate in group A was higher than that in group B and group C. There was no significant difference in HB and HCT, but it was worth noting that the decrease of hemoglobin and hematocrit before and after operation in group B was greater than that in group C (P 0.05). Conclusion. The blood loss and blood transfusion rate of total hip arthroplasty patients were significantly decreased by local application of carbamoic acid, and the hemostatic effect of local combined intravenous application was better, and the risk of venous thrombosis was not increased.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4

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本文編號：1674246