张新广;梁晓松;崔存宝;王东辰;高玉镭;田敏;刘淑磊;

• 1:解放军八十八医院

摘要(Abstract)：

[目的]探讨局部应用氨甲环酸联合可吸收止血纱布在单侧初次全膝关节置换术中止血的临床效果及安全性。[方法]选取2013年08月~2014年08月因膝关节骨性关节炎在本院行单侧人工全膝关节置换的192例患者进行研究。采用随机法将其分为四组:A组48例:关节内不使用氨甲环酸和可吸收止血纱布组;B组48例:缝合切口但未松止血带前将1片可吸收止血纱布放置关节内髌上囊处。C组48例:缝合切口但未松止血带前将氨甲环酸1.5 g粉剂直接撒入关节内;D组48例:缝合切口但未松止血带前先将氨甲环酸1.5 g粉剂直接撒入关节内再将1片可吸收止血纱布放置关节内髌上囊处。4组患者术后均放置负压引流管并在术后4 h内闭合引流管。比较4组患者术后的总失血量、隐性失血量、血红蛋白、引流量、输血量和输血人数,观察是否存在双下肢深静脉栓塞及肺栓塞的临床症状,出院时进行双下肢血管多普勒超声检查。[结果]将4组之间的血红蛋白、引流量、总失血量、输血人数和输血量进行两两比较,差异有统计学意义(P<0.05),隐性失血量进行两两比较,差异无统计学意义(P>0.05)、4组患者出院之前均未发现下肢深静脉血栓形成,差异无统计学意义。[结论]在血红蛋白、引流量、总失血量、输血人数和输血量方面,单纯使用可吸收止血纱布组优于未使用任何止血方法组,而只应用氨甲环酸组优于只应用可吸收止血纱布组,联合应用组优于其他三组,关节腔内局部应用氨甲环酸粉剂联合髌上囊应用可吸收止血纱布在单侧初次全膝关节置换中可明显减少总失血量及输血量、输血人数,并没有增加双下肢深静脉血栓形成的风险。

关键词(KeyWords)： 全膝关节置换;氨甲环酸;可吸收止血纱布

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张新广;梁晓松;崔存宝;王东辰;高玉镭;田敏;刘淑磊;

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