發(fā)布時間：2018-09-08 21:24

【摘要】：背景:氨甲環(huán)酸能夠明顯減少髖、膝關節(jié)置換術圍手術期失血,但氨甲環(huán)酸的給藥方式存在諸多爭議。目的:探討初次單側髖關節(jié)置換術后關節(jié)囊周圍注射氨甲環(huán)酸對失血量和關節(jié)功能的有效性和安全性。方法:應用回顧性研究方法對冀中能源峰峰集團邯鄲院區(qū)2013年1月至2016年1月選取股骨頭壞死合并髖關節(jié)骨性關節(jié)炎行初次單側全髖關節(jié)置換術的243例患者,男性131例,女性112例,年齡55~70歲平均年齡(62.2±4.1)歲。86例術中縫合前關節(jié)囊周圍注射1g氨甲環(huán)酸(氨甲環(huán)酸注射組),82例于手術切口前20分鐘靜點1g氨甲環(huán)酸生理鹽水50ml(氨甲環(huán)酸靜滴組),75例未使用氨甲環(huán)酸(無藥物干預組)。記錄三組患者術中失血量、術中輸血量、術中輸血率、手術時間和術后24小時引流量、術后輸血量、術后輸血率、術后血栓形成情況、術后髖關節(jié)Harris評分,計算三組患者總失血量和隱性失血量。結果:所有患者均順利完成手術,圍手術期未發(fā)生切口感染、不愈合、脂肪液化壞死等手術并發(fā)癥,無氨甲環(huán)酸副作用出現(xiàn)。三組病例性別、年齡、體重指數(shù)、病程、側別、手術時間、術前血容量、術中失血量、術中輸血率無統(tǒng)計學意義(P0.05)。術后輸血量:氨甲環(huán)酸注射組、氨甲環(huán)酸靜滴組、無藥物干預組比較有統(tǒng)計學差異(P0.05);其中氨甲環(huán)酸注射組與氨甲環(huán)酸靜滴組比較無統(tǒng)計學差異(P0.05)。術后輸血率:氨甲環(huán)酸注射組、氨甲環(huán)酸靜滴組、無藥物干預組比較有統(tǒng)計學差異(P0.05);其中氨甲環(huán)酸注射組與氨甲環(huán)酸靜滴組比較無統(tǒng)計學差異(P0.05)。術后隱性失血量:氨甲環(huán)酸注射組、氨甲環(huán)酸靜滴組、無藥物干預組比較有統(tǒng)計學差異(P0.05);其中氨甲環(huán)酸注射組與氨甲環(huán)酸靜滴組比較無統(tǒng)計學差異(P0.05)。術后引流量:氨甲環(huán)酸注射組、氨甲環(huán)酸靜滴組、無藥物干預組比較有統(tǒng)計學差異(P0.05);其中氨甲環(huán)酸注射組與氨甲環(huán)酸靜滴組比較無統(tǒng)計學差異(P0.05)�？偸а�:氨甲環(huán)酸注射組、氨甲環(huán)酸靜滴組、無藥物干預組比較有統(tǒng)計學差異(P0.05);其中氨甲環(huán)酸注射組與氨甲環(huán)酸靜滴組比較無統(tǒng)計學差異(P0.05)。氨甲環(huán)酸注射組、氨甲環(huán)酸靜滴組、無藥物干預組術后髖關節(jié)Harris評分比較無統(tǒng)計學差異(P0.05)。結論:全髖關節(jié)置換術中關節(jié)囊周圍注射和靜滴氨甲環(huán)酸均可減少術后失血量、術后輸血量、降低術后輸血率,未增加患肢靜脈血栓風險。兩種給藥方式對術后輸血量、術后失血量、術后輸血率無明顯差別。關節(jié)囊周圍注射氨甲環(huán)酸對術后髖關節(jié)功能無影響。
[Abstract]:Background: tranexamic acid can significantly reduce perioperative blood loss in hip and knee arthroplasty. Objective: to investigate the efficacy and safety of peri-capsular injection of aminoformic acid on blood loss and joint function after primary unilateral hip arthroplasty. Methods: from January 2013 to January 2016, 243 patients (131 males) with osteonecrosis of femoral head and osteoarthritis of hip joint underwent the first unilateral total hip arthroplasty in Handan Hospital of Jizhong Energy Fengfeng Group. 112 women, The mean age of 5570 years was (62.2 鹵4.1) years old. 86 patients with intraoperative injection of 1 g methocylic acid around the articular capsule (methocycline injection group) and 82 patients with intraoperative intraarticular capsule injection of 1 g 50ml (intraoperative intraarticular injection group) without intraoperative injection of methachlorocylic acid (50ml) were performed 20 minutes before the incision. Use carbamicylic acid (no drug intervention group). The blood loss, blood transfusion rate, operation time, 24 hours drainage rate, blood transfusion rate, postoperative thrombus formation, postoperative hip joint Harris score were recorded in the three groups. Total blood loss and hidden blood loss were calculated in the three groups. Results: all the patients completed the operation successfully. No incision infection, nonunion, fat liquefaction and necrosis were found in perioperative period. Gender, age, body mass index, course of disease, side, operation time, preoperative blood volume, intraoperative blood loss and blood transfusion rate were not statistically significant in the three groups (P0.05). The amount of blood transfusion after operation: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocycline injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). Postoperative blood transfusion rate: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocycline injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). The amount of recessive blood loss was significantly different between the two groups (P0.05), and there was no significant difference between the two groups (P0.05). Postoperative drainage: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocyclic acid injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). Total blood loss: methacylic acid injection group, methacylic acid intravenous drip group, no drug intervention group compared with statistical difference (P0.05); Ammonocyclic acid injection group and methacylic acid intravenous drip group had no statistical difference (P0.05). There was no significant difference in Harris score of hip joint between the two groups (P0.05). Conclusion: periarticular injection and intravenous drip of carbamoic acid in total hip arthroplasty can reduce postoperative blood loss, blood transfusion volume and blood transfusion rate, but do not increase the risk of venous thrombosis in the affected limbs. There was no significant difference in blood transfusion, blood loss and blood transfusion rate between the two methods. The postoperative hip function was not affected by intra-articular injection of carbamoic acid.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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