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

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>1 000 μg/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χ²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(χ²＝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。

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

ObjectiveTo prospectively evaluate the postoperative hemostatic effect of using tourniquet with different way during total knee arthroplasty(TKA) in patients with high coagulation condition. MethodsIn the prospective study, 92 cases of patients received TKA with different tourniquet applications were enrolled (D-Dimer>1 000 μg/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 χ² test using SPSS 19.0. ResultsThe 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(χ²=0.956, t=-0.329, both P>0.05). ConclusionUsing 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.