糖尿病对膝关节置换术围术期失血及术后疼痛的影响  

Effect of diabetes on perioperative blood loss and postoperative pain after knee replacement

作　　者：杨天翔 李俊[1] 常满 袁昂 王文鹏 程萌旗[2] 陈德胜 无 YANG Tianxiang;LI Jun;CHANG Man;YUAN Ang;WANG Wenpeng;CHENG Mengqi;CHEN Desheng;无(The third School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Department of Orthopedic,the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China;Department of Orthopedic,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;People′s Hospital of Ningxia Hui Autonomous Region Affiliated to Ningxia Medical University,Yinchuan 750002,China)

机构地区：[1]宁夏医科大学第三临床医学院,宁夏银川750004 [2]上海交通大学附属第六人民医院骨科,上海200233 [3]宁夏回族自治区人民医院骨科,宁夏银川750002 [4]宁夏医科大学附属自治区人民医院,宁夏银川750002

出　　处：《宁夏医学杂志》2024年第11期945-948,共4页Ningxia Medical Journal

基　　金：国家自然科学基金项目(82060408);宁夏科技厅重点研发项目(2021BEG03049);宁夏留学人员创新创业团队项目(NRS2021-5);宁夏回族自治区人民医院宁夏临床医学研究所开放课题(2023KFZD01)。

摘　　要：目的 探讨糖尿病对行人工全膝关节置换术(TKA)的膝骨性关节炎(KOA)患者围术期失血量及术后疼痛的影响。方法 回顾性收集并分析行单侧人工全膝关节置换术的92例患者的临床资料,依据患者既往是否患有糖尿病,将其分为糖尿病组(n=48)和非糖尿病组(n=44),检测并记录2组患者围手术期血红蛋白(Hb)和血细胞比容(Hct)变化,以及围手术期失血量、住院时间、视觉模拟评分法(VAS)得分等,记录患者围手术期下肢静脉血栓(DVT)及肺栓塞发生情况。结果 糖尿病组患者术前身体质量指数(BMI)大于非糖尿病组患者,差异有统计学意义(P<0.05);糖尿病组患者术后第3 d的Hb及Hct均显著低于非糖尿病组(P<0.05);糖尿病组患者的显、隐性失血量及总失血量均多于非糖尿病组,术后DVT发生率及输血率高于非糖尿病组,住院总时间长于非糖尿病组,差异均有统计学意义(P<0.05);术后第3 d时糖尿病组患者VAS评分大于非糖尿病组,差异有统计学意义(P<0.05);2组患者均无切口感染、肺栓塞等并发症。结论 糖尿病可使TKA围手术期出血量增多,增加患者的手术风险和术后感染的可能,并加剧患者术后疼痛,影响患者术后功能恢复。Objective To investigate the effect of diabetes mellitus(DM)on perioperative blood loss and postoperative pain in patients with osteoarthritis undergoing total knee arthroplasty(TKA).Methods Retrospective Collected and analyzed the clinical data of 92 patients who underwent unilateral total knee arthroplasty.According to whether they had DM,they were divided into DM group(48 cases)and non-DM group(44 cases).Detected and recorded the changes in perioperative hemoglobin(Hb)and hematocrit(Hct)in the two groups,as well as perioperative blood loss,length of stay,visual analogue scale(VAS),etc.Recorded perioperative deep Venous Thrombosis(DVT)and pulmonary embolism happened.Results The preoperative Body Mass Index(BMI)of patients with DM was greater than that of patients with non-DM(P<0.05);the Hb and Hct of the diabetic group on the third day after surgery were significantly lower than those of the non-diabetic group(P<0.05);the hidden blood loss and total blood loss of the diabetes group were more than those of the non-diabetic group,postoperative DVT incidence and blood transfusion rate are higher than non-diabetic group,and the total length of hospital stay was longer than that of the non-diabetic group.There were differences statistically significant(P<0.05);on the 3rd day after surgery,the VAS score of the diabetic group was greater than that of the non-diabetic group,and the difference was statistically significant(P<0.05);there was no incision infection,pulmonary embolism and other complications in the two groups.Conclusion The patients with DM could increase the amount of bleeding during the perioperative period of TKA and aggravate the postoperative pain of the patient.

关 键 词：膝骨性关节炎 人工全膝关节置换术 糖尿病 围手术期失血量 

分 类 号：R684[医药卫生—骨科学]