高凝血状态患者人群全膝关节置换术中应用止血带的对照研究  

Controlled study of tourniquet in total knee arthroplasty of patients with high coagulation condition

作　　者：杨健齐[1] 杨林[1] 张健平[1] 曾昭勇[1] 蔡道章 Yang Jianqi;Yang Lin;Zhang Jianping;Zeng Zhaoyong;Cai Daozhang(Department of Joint surgery,The first people’s hospital of Foshan,Foshan 528000,China;Department of Joint surgery,The third affiliated hospital of southern medical university,Guangzhou 510000,China)

机构地区：[1]佛山市第一人民医院骨科,528000 [2]南方医科大学第三附属医院关节外科,广州510000

出　　处：《中华关节外科杂志（电子版）》2018年第4期495-500,共6页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨高凝血状态患者人群全膝关节置换术中不同止血带应用方式对围手术期出血的影响。方法采用随机对照研究,对比观察92例使用不同止血带应用方式的全膝关节置换术患者,纳入标准:血浆D-二聚体> 1 000μg/L(酶联免疫荧光法),随机分为半程止血带组(n=46)和全程止血带组(n=46),半程止血带组在安装假体时使用止血带,全程止血带组手术全程使用止血带,记录两组患者手术时间、术后引流量、隐性失血量、失血总量、血红蛋白丢失量、输血率、平均输血量、膝关节活动度、疼痛评分、膝关节活动度、肢体肿胀及并发症情况,用SPSS 19. 0软件对两组结果进行比较,手术时间和引流量等计量资料采用t检验,并发症等计数资料采用2检验。结果半程止血带组术后引流量、隐性失血量、总失血量、血红蛋白丢失量、疼痛评分、肢体肿胀及并发症发生率显著低于全程止血带组(t=-7. 432、-15. 72、-2. 205、-2. 746、-3. 070、-5. 525,P <0. 05),半程止血带组手术时间、膝关节活动度显著高于全程止血带组(t=8. 098,t=2. 290,P <0. 05),两组术后输血率和平均输血量比较差异无统计学意义(2=0. 956,t=-0. 329,均为P> 0. 05)。所有患者均无症状性肺栓塞、感染及伤口皮缘坏死发生。结论高凝血状态患者行全膝关节置换术中半程使用止血带止血效果优于全程止血带,止血带相关并发症发生率低于全程使用止血带组。Objective To prospectively evaluate the postoperative hemostatic effect of using tourniquet with different way during total knee arthroplasty(TKA)in patients with high coagulation condition.Methods In the prospective study,92 cases of patients received TKA with different tourniquet applications were enrolled(D-Dimer>1 000μg/L)and randomly divided into group A(half-course group,n=46)using tourniquet only during cementation and group B(whole-course group,n=46)using tourniquet from incision to wound closure.The operation duration,wound drainage,hidden blood loss,total blood loss,hemoglobin loss,blood transfusion rate,average transfusion volume,pain score,range of motion,limb-swelling and complication were recorded and analyzed by t test and 2 test using SPSS 19.0.Results The wound drainage,hidden blood loss,total blood loss,hemoglobin loss,pain score,limb-swelling and complications in group A were significantly lower than those in group B(t=-7.432,-15.72,-2.205,-2.746,-3.070,-5.525,all P<0.05).The operation duration and range of motion were significantly higher in group A than those in group B(t=8.098,2.290,both P<0.05),there was no significant difference in blood transfusion rate and average transfusion volume between two groups(2=0.956,t=-0.329,both P>0.05).Conclusion Using half-course tourniquet has a better hemostatic effect and a lower complication suffering rate than using whole-course tourniquet after TKA in the patients with high coagulation condition.

关 键 词：关节成形术 置换 膝 止血带 血液凝固 

分 类 号：R687.4[医药卫生—骨科学]