摘要
背景:膝关节单髁置换用于治疗膝关节骨关节炎单间室病变逐渐兴起,而关节置换围手术期出血量的管理是临床研究的热点。对围手术期总失血量的把握,对围手术期血红蛋白等检验指标变化规律的了解,可以保障患者术后的安全、促进恢复。目的:描述膝关节单髁置换全程出血管理期间患者血液相关观察指标的变化规律,为临床减少失血量提供技术借鉴?方法:回顾性分析广东省中医院骨关节科2015年1至12月收治70例单髁置换患者的临床资料,所有患者执行全程出血管理,观察患者手术时间?术中出血量?术后引流量、总失血量、输血率;收集围手术期血红蛋白、白蛋白、凝血3项、D-二聚体、血沉、C-反应蛋白等相关观察指标并描述其变化规律。分析手术时间对术后失血量及引流量的影响。结果与结论:(1)患者手术时间(89.36±19.89)min,术中出血量(39.71±23.64)m L,术后引流量(56.21±34.21)m L,自体血回输率为0;(2)手术时间对术中出血无影响(P=0.685 7),手术时间对术后引流量有影响(P=0.021 6);(3)术后总出血量较少。经检验,术后3 h?1 d?3 d和7 d总出血量之间对比,差异无显著性意义(P>0.05);(4)术后1-3 d血红蛋白小幅度下降后缓慢回升;术后1 d内血沉、C-反应蛋白快速上升,1-3 d内快速下降,3-7 d内缓慢下降;D-二聚体术后1 d快速上升,术后1-3 d快速下降,术后3-7 d缓慢上升;术后1-3 d内血清总蛋白、白蛋白小幅度下降后基本稳定,波动在正常参考范围内;(5)结果表明,膝关节单髁置换手术时间短,术后总失血量较少且波动幅度小,围手术期血液相关检查指标存在不同程度的波动。全程出血管理可以降低围手术期患者总失血量,降低输血率。
BACKGROUND:Unicompartment knee arthroplasty(UKA)is gradually applied in the treatment of knee osteoarthritis,and the management of perioperative blood loss is a hot spot in clinical research.It is very important to control perioperative blood loss and changes in hemoglobin level for postoperative rapid recovery.OBJECTIVE:To investigate the changes in the blood-related indexes during the management of perioperative blood loss in UKA,so as to provide technical reference and data reference for clinical application.METHODS:Clinical data 70 patients undergoing UKA at the Department of Bone and Joint of Guangdong Provincial Hospital of Chinese Medicine from January to December 2015 were analyzed retrospectively,and received the management of perioperative blood loss.The operation time,intraoperative blood loss,postoperative drainage volume,total blood loss and rate of blood transfusion were recorded;the preoperative hemoglobin,albumin,coagulation indexes,D-dimer,erythrocyte sedimentation rate and C-reactive protein were investigated.The effect of operation on the postoperative blood loss and drainage volume was analyzed.RESULTS AND CONCLUSION:(1)The operation time was(89.36±19.89)minutes,intraoperative blood loss was(39.71±23.64)mL,postoperative drainage volume was(56.21±34.21)mL,and rate of autologous blood transfusion was 0.(2)The operation time exerted no effect on the intraoperative blood loss(P=0.685 7),but affected on the postoperative drainage volume(P=0.021 6).(3)The total postoperative blood loss was little,and the blood loss did not differ significantly at 3 hours,1,3 and 7 days postoperatively(P>0.05).(4)There was a slight decline in hemoglobin on days 1-3 after surgery,and then returned slowly;the erythrocyte sedimentation rate and C-reactive protein increased rapidly within 1 day after surgery and declined within 1-3 days;the D-dimer rapidly increased on day 1 after surgery,then rapidly decreased on days 1-3,and then slowly increased on days 3-7;the plasma total protein and albumin were stable and fluct
作者
崔苛苛
杨伟毅
刘军
潘建科
张葆青
张小亮
曹学伟
Cui Ke-ke;Yang Wei-yi;Liu Jun;Pan Jian-ke;Zhang Bao-qing;Zhang Xiao-liang;Cao Xue-wei(School of Second Clinical Medicine of Guangzhou University of Chinese Medicine,Guangzhou 510000,Guangdong Province,China;Department of Orthopedics,Second Affiliated Hospital of Guangzhou University of Chinese Medicine(Guangdong Provincial Hospital of Chinese Medicine),Guangzhou 510000,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2018年第3期336-342,共7页
Chinese Journal of Tissue Engineering Research
基金
国家自然科学基金项目(81473698)
教育部高等学校博士点科研基金项目(20124425110004)
广东省科技计划项目(2011B031700027)
广东省财政厅项目([2014]157号)
广东省中医药管理局项目(20164020)
广东省中医院中医药科学技术研究专项(YK2013B2N19
YN2015MS15)~~
关键词
关节成形术
白蛋白类
血沉
C反应蛋白质
组织工程
Arthroplasty
Albumins
Blood Sedimentation
C-Reactive Protein
Tissue Engineering
