不同干预措施对全膝关节置换术围手术期出血的影响

目的探讨止血带松开时机和引流管夹闭对全膝关节置换术(TKA)围手术期出血的影响。方法将70例单膝TKA治疗的膝骨关节炎患者分别采用术中关闭伤口前电凝止血后松开止血带、术后夹闭引流管6h(观察组,40例)和术中全程使用止血带、术后引流管处于自然开放引流状态(对照组,30例),观察两者的出血量及下肢静脉血栓形成情况。结果观察组术中出血量明显多于对照组(P0.05),但术后引流量、隐性失血量及总失血量均明显小于对照组(P0.05)。输血例数及输血量:观察组11例(27.5%),平均输血量2.7 U;对照组24例(80.0%),平均输血量3.4 U;两组比较差异有统计学意义(P0.01)。术后深、浅静脉血栓形成例数:观察组5例(12.5%),对照组1例(3.3%),但差异无统计学意义(P0.05)。结论术中闭合伤口前电凝止血后松开止血带、术后夹闭引流管6 h能够明显减少TKA围手术期的总出血量,但能增加下肢静脉血栓形成。

Different interventions on perioperative bleeding effect of total knee arthroplasty

Objective To explore effect of the timing of tourniquet loosened and clipping drainage tube on periopera-tive bleeding of total knee arthroplasty ( TKA ) . Methods Total 70 cases of knee osteoarthritis patients on single knee TKA treatment before surgery were used to close the wound tourniquet release with coagulation hemostasis, post-operative drainage tube clamping 6 h ( observation group, 40 cases) and the full use of intraoperative tourniquet and postoperative open drainage tube drainage in the natural state ( control group,30 cases) , and both of the bleeding vol-ume and venous thrombosis were observed. Results Observation group blood loss was significantly more than that of the control group (P<0. 05), but the postoperative drainage, hidden blood loss and total blood loss were significant-ly lower than that of the control group (P<0. 05). The differences were statistically significant. Blood transfusion ca-ses:the observation group was 11 cases ( 27. 5%) , the average volume of blood transfusion was 2. 7 U; control group, 24 cases(80. 0%), the average volume of blood transfusion was 3. 4 U;the difference of two groups was sta-tistically significant (P<0. 01). The number of cases between the two groups after the venous thrombos:observation group was 5 cases ( 12. 5%); control group 1 patient ( 3. 3%); there was no significant difference ( P >0. 05 ) . Conclusions To loosen the tourniquet and stop bleeding with coagulation hemostasis before wound closure in opera-tion, and occlusion of the drainage tube 6 h after operation, which can significantly reduce the total TKA perioperative bleeding, but it can increase the venous thrombosis of lower extremity.