术中控制性低血压对人工膝关节置换术疗效的影响  

Effect of Intraoperative Controlled Hypotension on the Outcome of Artificial Knee Joint Replacement

作　　者：伍旭林 朱伟民 唐本森 周广福 邱冰 刘懋 杨洋 WU Xulin;ZHU Weimin;TANG Bensen;ZHOU Guangfu;QIU Bing;LIU Mao;YANG Yang(Department of Joint Surgery,Guizhou Orthopedics Hospital,Guiyang Guizhou 550007,China)

机构地区：[1]贵州省骨科医院关节外科

出　　处：《河南医学高等专科学校学报》2019年第4期423-426,共4页Journal of Henan Medical College

基　　金：贵阳市科技计划项目([2018]1-69)

摘　　要：目的探讨控制性低血压在人工膝关节置换术(total knee arthroplasty,TKA)中的应用效果。方法选取TKA患者80例,采用随机数字表法分为观察组和对照组,各40例。所有患者均采用蛛网膜下隙与硬脊膜外联合阻滞麻醉,观察组术中采用持续静脉泵注硝酸甘油维持平均动脉压(MAP)处于75~80 mmHg水平,对照组仅采用下肢气囊止血带止血,不进行其他降压处理。比较2组手术时间、平均住院时间、术中输液量、出血量、术后24 h引流量,术后24、48 h疼痛评分及并发症情况。结果所有患者均经治愈后出院,观察组手术时间为(1.11±0.23)h,对照组(1.22±0.24)h,观察组短于对照组;观察组住院时间为(11.67±2.46)d,对照组(13.22±3.28)d,观察组短于对照组;观察组术中收缩压(SBP)为(90.33±8.44)mmHg,舒张压(DBP)(62.31±6.43)mmHg,对照组收缩压(SBP)(135.41±14.67)mmHg,舒张压(DBP)(75.52±12.75)mmHg,观察组术中SBP、DBP低于对照组;观察组术中出血量(158.87±50.67)mL,对照组(296.61±78.35)mL,观察组较对照组少;观察组输液量(2 413.36±102.57)mL,对照组(3 142.55±152.36)mL,观察组较对照组少;观察组术后24 h引流量(86.63±22.43)mL,对照组(127.25±63.47)mL,观察组少于对照组;观察组术后24、48 h VAS评分及术后并发症发生情况均少于或低于对照组;以上指标差异均有统计学意义(P<0.05)。结论控制性低血压技术可明显缩短TKA患者手术及住院时间,降低术中出血量、输液量及术后24 h引流量,减轻术后疼痛程度且术后并发症低,临床效果较好。Objective To investigate the effect of controlled hypotension in total knee arthroplasty(TKA).Methods 80 TKA patients admitted were selected and divided into control group and observation group with 40 cases each group by random number table method.All patients were anesthetized with combined spinal-epidural anesthesia.In the observation group,the mean arterial pressure(MAP)was maintained at 75-80 mmHg by continuous intravenous infusion of nitroglycerin.In the control group,only lower limb balloon tourniquet was used to stop bleeding,and no other antihypertensive treatment was performed.The operation time,average hospitalization time,intraoperative infusion volume,bleeding volume,24-hour drainage volume,24-hour and 48-hour pain score and complications were compared between the two groups.Results All patients were discharged after cure.The operation time of the observation group was(1.11±0.23)h,the control group(1.22±0.24)h,the observation group was shorter than the control group;the observation group was hospitalized(11.67±2.46)d,the control group(13.22±3.28)d,the observation group was shorter than the control group;the intraoperative systolic blood pressure(SBP)(90.33±8.44)mmHg,diastolic blood pressure(DBP)(62.31±6.43)mmHg,and the control group systolic blood pressure(SBP)(135.41±14.67)mmHg,diastolic Pressure(DBP)(75.52±12.75)mmHg,the SBP and DBP in the observation group were lower than the control group;the intraoperative blood loss was(158.87±50.67)mL,the control group was(296.61±78.35)mL,the control group was less than the control group;the infusion volume of the observation group was(2 413.36±102.57)mL,and the control group was(3 142.55±152.36)mL,the infusion volume of the observation group was less than that of the control group;the observation group received drainage volume was(86.63±22.43)mL at 24 h after operation,the control group was(127.25±63.47)mL,the observation group was less than the control group;the VAS score and postoperative complications of the observation group were less or low

关 键 词：人工膝关节置换术 控制性低血压 蛛网膜下隙与硬脊膜外联合阻滞麻醉 临床研究 

分 类 号：R687.4[医药卫生—骨科学]