微创全髋关节围置换期应用重组人促红细胞生成素联合氨甲环酸  

Application of recombinant human erythropoietin combining with tranexamic acid in perioperative period of minimally invasive total hip arthroplasty

作　　者：张涵 胡正霞[2] 兰海[2] Zhang Han;Hu Zheng-xia;Lan Hai(Department of Graduate School,Zunyi Medical College,Zunyi 563000,Guizhou Province,China;Department of Orthopedic Surgery,the Affiliated Hospital,Clinical Medical College of Chengdu University,Chengdu 610081,Sichuan Province,China)

机构地区：[1]遵义医学院研究生院,贵州省遵义市563000 [2]成都大学附属医院骨外科,四川省成都市610081

出　　处：《中国组织工程研究》2018年第7期1003-1008,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目<基于3D显微CT图像相关技术等的骨疲劳损伤机理及寿命预测研究>(11572057)~~

摘　　要：背景:微创全髋关节置换较传统入路关节置换切口小,组织损伤轻,但围置换期贫血仍然常见,影响髋关节功能恢复,增加患者负担。目的:观察重组人红细胞生成素对微创行全髋关节置换后失血性贫血的疗效评价。方法:收集35例在成都大学附属医院骨科行Super PATH微创全髋关节置换患者的临床资料,按照是否应用重组人促红细胞生成素,将患者分为试验组(n=18),对照组(n=17)。试验组置换前3 d开始皮下注射重组人红细胞生成素,1次/d,至置换后8 d,共12 d,用药期间同时补充蔗糖铁,1次/d,氨甲环酸1 g于置换前0.5 h静脉输注,关节置换中1 g冲洗髓腔;对照组:仅补充蔗糖铁,1次/d,氨甲环酸置换前0.5 h静脉输注,置换中冲洗髓腔。于入院当天、置换前第3天、置换当天、置换后第4,8天分别监测患者的血红蛋白水平及红细胞压积,同时记录关节置换时间、失血量、置换前及置换后4 d目测类比疼痛评分、置换前及置换后4,8 d髋关节Harris功能评分。结果与结论:(1)两组患者基线资料相比,差异无显著性意义(P>0.05);(2)两组置换4 d目测类比疼痛评分均较置换前显著降低(P<0.05),各时间点组间比较差异无显著性意义(P>0.05)。两组患者置换前及置换后1 d Harris髋关节评分比较,差异无显著性意义(P>0.05),置换后4 d,试验组Harris评分显著高于对照组(P<0.05)。两组患者平均失血量及关节置换时间相比,差异无显著性意义(P>0.05);(3)入院当天及置换前1 d血红蛋白及红细胞压积相比,两组无显著性差异(P>0.05),置换后急查,4,8 d血红蛋白及红细胞压积相比,试验组显著高于对照组(P<0.05)。不同组血红蛋白水平及及红细胞压积变化趋势基本一致,相较于对照组,试验组下降趋势更加平缓,回升趋势相对陡急;(4)结果提示,在微创行全髋关节置换围置换期使用重组人促红细胞生成素加用蔗糖铁,联合氨甲环酸,能有效改善患者�BACKGROUND:Minimally invasive total hip arthroplasty is less invasive and has less tissue injury than traditional approach.However,perioperative anemia is still common,affecting hip function recovery and increasing patient burden.OBJECTIVE:To assess the curative effects of recombinant human erythropoietin on hemorrhagic anemia after minimally invasive total hip arthroplasty.METHODS:Clinical data of 35 patients undergoing SuperPATH minimally invasive total hip arthroplasty in the Department of Orthopedic Surgery,the Affiliated Hospital/Clinical Medical College of Chengdu University were collected.The patients were divided into the control group(n=17)and the erythropoietin group(n=18)according to the presence and absence of erythropoietin.The patients in the erythropoietin group were subcutaneously injected with recombinant human erythropoietin 3 days before replacement,once a day,lasting to 8 days after operation,for 12 consecutive days.During erythropoietin administration,iron sucrose was added once a day.Tranexamic acid 1 g was intravenously infused 0.5 hour before replacement,and 1 g for washing medullary cavity during replacement.The patients in the control group only took iron sucrose,once a day,adding tranexamic acid through intravenous infusion 0.5 hour before replacement.Levels of hemoglobin and hematocrit were monitored on the day of admission,the preoperative 3 days,the operation day,the postoperative 4 days and the postoperative 8 days.The operation time,blood loss,Visual Analogue Scale pain score 4 days before and after replacement and Harris hip function score before replacement,4 and 8 days after replacement were recorded.RESULTS AND CONCLUSION:(1)Baseline data were not significantly different between the two groups(P>0.05).(2)Visual Analogue Scale pain score significantly decreased 4 days after replacement in both groups(P<0.05),and was not significantly different between both groups at various time points(P>0.05).Harris hip score was not significantly different before and 1 day after replacement be

关 键 词：关节成形术 置换 髋 外科手术 微创性 红细胞生成素 重组 氨甲环酸 止血 

分 类 号：R318[医药卫生—生物医学工程]