中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (48): 7156-7162.doi: 10.3969/j.issn.2095-4344.2016.48.002

• 人工假体 artificial prosthesis • 上一篇    下一篇

鸡尾酒疗法减少全髋关节置换后的隐性失血

时利军,白 禹,高福强,孙 伟,王卫国,程立明,郭万首   

  1. 北京中日友好医院骨关节外科,北京市 100029
  • 修回日期:2016-08-28 出版日期:2016-11-25 发布日期:2016-11-25
  • 通讯作者: 孙伟,男,主任医师,教授,博士生导师,北京大学中日友好医院骨关节外科,北京市 100029
  • 作者简介:时利军,男,1990年生,河南省开封市人,汉族,北京大学医学部中日友好临床医学院在读硕士,主要从事股骨头坏死的基础和临床研究。 并列第一作者:白禹,女,1980年生,北京市人,汉族,主要从事手术麻醉的配合及手术患者的护理研究。
  • 基金资助:

    国家自然科学基金(81273972);中日友好医院青年科技英才计划 (2014-QNYC-A-06)

Cocktail therapy reduces hidden blood loss after total hip arthroplasty

Shi Li-jun, Bai Yu, Gao Fu-qiang, Sun Wei, Wang Wei-guo, Cheng Li-ming, Guo Wan-shou   

  1. Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
  • Revised:2016-08-28 Online:2016-11-25 Published:2016-11-25
  • Contact: Sun Wei, Chief physician, Professor, Doctoral supervisor, Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
  • About author:Shi Li-jun, Studying for master’s degree, Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China Bai Yu, Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81273972; the Youth Science and Technology Talent Project of China-Japan Friendship Hospital, No. 2014-QNYC-A-06

摘要:

文章快速阅读:

 

 

文题释义:
隐性失血:由于全髋关节置换手术创伤引起血液大量进入组织间隙,积留在关节腔内,还有一部分为假体和肌肉周围形成的血肿,以及由于溶血作用所导致的血红蛋白丢失,学者称这种现象为隐性失血。隐性失血的主要临床表现是肢体肿胀及较大面积的瘀斑,影响患者术后功能恢复。
氨甲环酸:是一种人工合成的赖氨酸类似物,通过竞争性阻断纤溶酶原的赖氨酸结合位点,抑制纤溶酶原与纤维蛋白结合,产生抑制纤维蛋白溶解的效果。研究报道,氨甲环酸可抑制纤溶酶介导的纤维蛋白溶解长达17 h,其次氨甲环酸还可以促进血凝块在组织间的沉积,增加血块的稳定性。
 
摘要
背景:目前可采用应用肾上腺素、氨甲环酸、止血凝胶和止血粉末等减少患者全髋关节置换后的局部失血,但单独采用某一种方法都不能达到理想的止血效果。
目的:评估鸡尾酒疗法对单侧全髋关节置换后患者失血量及输血率的影响。
方法:将125例股骨头缺血坏死患者随机分为2组,均进行初次单侧全髋关节置换,鸡尾酒组(n=64)在关闭肌肉筋膜层之后局部关节腔内注射鸡尾酒(3 g氨甲环酸和0.25 mg稀释性肾上腺素的混合液),氨甲环酸组(n=61)关闭肌肉筋膜层之后局部关节腔内单纯注射含3 g氨甲环酸的生理盐水。术后第1,3,5天分析失血量及输血率,随访观察深静脉血栓与肺动脉栓塞发生情况。
结果与结论:术后第3天,鸡尾酒组总失血量、隐性失血量及血红蛋白下降值均低于氨甲环酸组(P < 0.05);两组术中失血量及输血率比较差异无显著性意义;两组患者均无切口感染、血压骤升、症状性肺栓塞和下肢深静脉血栓形成等情况出现,未见氨甲环酸相关不良反应。结果表明,鸡尾酒疗法在首次单侧全髋关节置换中可以有效减少患者术后隐性失血量,同时不会产生严重的不良反应及并发症。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

ORCID:
0000-0001-6559-1604(时利军)

关键词: 骨科植入物, 人工关节, 全髋关节置换, 局部应用, 鸡尾酒, 氨甲环酸, 肾上腺素, 输血, 隐性失血, 国家自然科学基金

Abstract:

BACKGROUND: Epinephrine solution, tranexamic acid, hemostatic gels and powders have been used to reduce topical blood loss after total hip arthroplasty; however, none of these methods alone is sufficient.

OBJECTIVE: To evaluate the efficacy of cocktail therapy on blood loss and transfusion rate after unilateral total hip arthroplasty. 
METHODS: 125 patients with avascular necrosis of the femoral head were randomly divided into two groups. All patients received primary unilateral total hip arthroplasty. In the cocktail therapy group (n=64), cocktail (3 g of tranexamic acid and 0.25 mg diluted epinephrine solution) was intraarticlarly injected after musculoaponeurotic surgical closure. In the tranexamic acid group (n=61), physiological saline containing 3 g tranexamic acid was intraarticlarly injected after musculoaponeurotic surgical closure. Blood loss and transfusion rate were analyzed on postoperative days 1, 3, 5, and deep venous thrombosis and pulmonary embolism were followed up. 
RESULTS AND CONCLUSION: Total blood loss, hidden blood loss and hemoglobin loss were lower in the cocktail therapy group than in the tranexamic acid group (P < 0.05). There was no significant difference in intraoperative blood loss and transfusion rate between the two groups. No incision infection, sudden excessive increases in blood pressure, symptomatic deep venous thrombosis, pulmonary embolism, or tranexamic acid-related complications was detected in either group. These results suggested that topical application of cocktail wine in total hip arthroplasty can effectively decrease postoperative hidden blood loss without serious adverse reaction or substantial complications. 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Arthroplasty, Replacement, Hip, Tranexamic Acid, Epinephrine, Postoperative Hemorrhage, Tissue Engineering

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