马栗种子提取物对全膝关节置换后早期隐性失血量与肢体周径变化的影响  

Effects of horse chestnut seed extract on early hidden blood loss and limb circumference changes after total knee arthroplasty

作　　者：高福强[1] 孙伟[1] 马金辉[2] 李子荣[1] 

机构地区：[1]北京中日友好医院骨关节外科,骨坏死与关节保留重建中心,北京市100029 [2]北京大学中日友好临床医学院,北京市100029

出　　处：《中国组织工程研究》2014年第48期7726-7731,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金面上项目(81372013);中日友好医院面上项目(2013-MS-27)~~

摘　　要：背景:有研究表明,全膝关节置换后肢体肿胀主要还是与隐性失血有关。马栗种子提取物的主要成分是七叶皂苷,有保护血管,增加血管张力,降低毛细血管通透性,抗水肿,抗炎、抗渗出的作用,可有效预防和治疗创伤后肢体肿胀。目的:探讨马栗种子提取物对初次全膝关节置换后隐性失血量与肢体周径变化的影响及病理机制。方法:回顾性分析2013年1至9月接受全膝关节置换的150例患者,其中试验组85例置换后当日开始口服消肿药物马栗种子提取物0.3 g,3次/d,共14 d;对照组65例并未给予消肿药物。两组患者的年龄、身高及体质量指数等参数差异均无显著性意义(P>0.05),具有可比性。置换后1-3 d复查血常规。记录术中及置换后失血量和输血量,应用Gross方程计算置换后隐性失血量。观察并测量患者围手术期患膝髌上10 cm大腿周径的变化。两组间比较采用两独立样本t检验。结果与结论:试验组和对照组隐性失血量分别为(590.6±214.2),(821.2±457.3)m L,差异有显著性意义(t=3.238,P=0.021)。试验组置换后失血总量、置换后第2,3天膝上10 cm大腿周径变化均明显小于对照组(P<0.05),而两组置换后第1天膝上10 cm大腿周径变化和引流量差异无显著性意义(P>0.05)。提示早期应用马栗种子提取物可显著减少初次全膝关节置换后隐性失血,明显缓解置换后肢体肿胀,有利于促进肢体功能康复。其消肿的机制可能是减少置换后隐性失血,促进静脉回流。BACKGROUND： The swelling of limbs after total joint arthroplasty is associated with the hidden blood loss. The main component of horse chestnut seed extract is Aescine, which can protect blood vessels, increase vascular tension, reduce capillary permeability, and exert anti-edema, anti-inflammation, and anti-exudation effect. This extract can prevent and treat post-traumatic swelling of the limbs. OBJECTIVE： To investigate the pathological mechanisms and effects of horse chestnut seed extract on early hidden blood loss and limb circumference changes after total knee arthroplasty. METHODS： A total of 150 patients undergoing total knee arthroplasty from January 2013 to September 2013 were retrospectively analyzed. The involved cases were divided into two groups. The test group of 85 cases received oral administration of 0.3 g horse chestnut seed extract, three administrations per day, from the first day after total knee arthroplasty. The administration was given for 14 days. Control group of 65 patients received no detumescence drugs. There were no significant differences in patient’s age, body height and body mass index between two groups （P 〉 0.05）. Blood routine examination was performed at 1-3 days after total knee arthroplasty. The amounts of intraoperative blood loss, postoperative blood loss, and postoperative blood transfusion were recorded. The hidden blood loss was calculated according to the Gross formula. Perioperative limb circumference above the knees was observed and measured. Two-independent-sample t-test was used to compare the difference between the two groups. RESULTS AND CONCLUSION： Hidden blood loss between the test group and control group was （590.6±214.2） and （821.2±457.30） mL, respectively, the difference was significant （t=3.238, P=0.021）. The postoperative total blood loss and the thigh circumference changes above knee in test group were less significantly than that in control group within 2 and 3 days after surgery （P 〈 0.05）. And there was no statis

关 键 词：植入物 人工假体 全膝关节置换 隐性失血 肿胀 马栗种子提取物 肢体功能 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]