尿毒症患者行人工全髋关节置换围手术期血液透析策略

目的探究尿毒症患者行人工全髋关节置换围手术期的血液透析策略。方法本次研究为回顾性分析,选取海军军医大学附属长征医院关节外科在2006年6月至2017年6月收治的74例患有尿毒症需要进行定期血液透析,并进行初次人工全髋关节置换手术治疗的患者作为研究对象。对照组在术前1 d及术后第1天进行无肝素血透,研究组在术前1 d及术后第1天进行低分子肝素血透。对照组37例,男11例,女26例;年龄49~77岁,平均年龄(66.8±5.9)岁;透析病程2~7年,平均病程(4.3±1.8)年。研究组37例,男15例,女22例;年龄55~83岁,平均年龄(71.5±6.3)岁;透析病程1~8年,平均病程(5.1±1.2)年。观察两组患者手术后肾功能、血红蛋白降低量、凝血指标、关节功能恢复情况并进行对比。结果所有患者均获得随访,随访时间13~102个月,平均(34.5±6.8)个月。术前血透后、术后血透后和术后3 d时研究组血尿素氮、血钾和血肌酐指标均优于对照组(P<0.05);两组术后凝血功能、出血量以及髋关节功能Harris评分差异均无统计学意义(P>0.05)。结论尿毒症患者行人工全髋关节置换围手术期采用无肝素血透与低分子肝素血透比较,在术后出血量、凝血功能及关节功能恢复情况方面差异无统计学意义,但使用低分子肝素血透的患者肾功能指标明显优于无肝素血透患者。这提示我们,对于需要进行人工全髋关节置换手术的尿毒症患者,围手术期建议采用低分子肝素血透方法,有助于保护患者肾功能,提高手术的安全性,降低风险,值得在临床上推广使用。

Perioperative Hemodialysis Strategy for Total Hip Arthroplasty in Patients with Uremia

Objective To explore the perioperative hemodialysis strategy of uremia patients undergoing total hip arthroplasty.Methods This study was a retrospective analysis.74 patients with uremia who were admitted to the joint surgery department of Changzheng Hospital Affiliated to the Naval Military Medical University from June 2006 to June 2017 were selected as the study objects.Heparin-free hemodialysis was performed in the control group 1 day before surgery and on the first day after surgery.The study group was used low molecular weight heparin hemodialysis 1 day before surgery and on the first day after surgery.The renal function,hemoglobin reduction,blood coagulation index and joint function recovery of the two groups were observed and compared.Results All patients were followed up for 13~102 months,with an average of(34.5±6.8)months.The indexes of blood urea nitrogen,blood potassium and blood creatinine in the study group were better than those in the control group(P<0.05).There were no significant differences in the Harris scores of coagulation function,bleeding volume and hip joint function after surgeries between the two groups(P>0.05).Conclusion For uremic dialysis patients,there was no significant difference in postoperative bleeding,blood coagulation,and joint function recovery between heparin-free hemodialysis and low-molecular-weight heparin hemodialysis during total hip arthroplasty.However,the renal function of patients with low molecular weight heparin hemodialysis is significantly better than that of patients without heparin hemodialysis.This suggests that for patients with uremia who require total hip arthroplasty,low-molecular-weight heparin hemodialysis is recommended during the perioperative period,which helps to protect patients'renal function,improve the safety of surgery,and reduce the risks.This deserves to be widely used in clinical practice.