文章摘要
杨佳瑞,王志猛,乔瑞,等.氨甲环酸结合术后引流管临时夹闭对减少肘关节僵硬松解术出血的有效性分析.骨科,2021,12(3): 254-259.
氨甲环酸结合术后引流管临时夹闭对减少肘关节僵硬松解术出血的有效性分析
Effectiveness of temporary clamping of drainage tube combined with tranexamic acid in reducing bleeding of elbow stiffness
投稿时间:2020-07-20  
DOI:10.3969/j.issn.1674-8573.2021.03.012
中文关键词: 氨甲环酸  肘关节僵硬  肘关节松解术  引流管夹闭  失血量
英文关键词: Tranexamic acid  Elbow stiffness  Elbow lysis  Drainage tube clamping  Blood loss
基金项目:陕西省重点研发计划(2017ZDXM-SF-009)
作者单位E-mail
杨佳瑞 西安医学院西安 710021西安交通大学医学院附属红会医院创伤骨科西安 710054  
王志猛 西安医学院西安 710021  
乔瑞 西安医学院西安 710021  
杨琨 西安医学院西安 710021  
李树灏 西安医学院西安 710021  
樊伟 西安交通大学医学院附属红会医院创伤骨科西安 710054  
王晓龙 西安交通大学医学院附属红会医院创伤骨科西安 710054  
衡立松 西安交通大学医学院附属红会医院创伤骨科西安 710054  
朱养均 西安交通大学医学院附属红会医院创伤骨科西安 710054  
张堃 西安交通大学医学院附属红会医院创伤骨科西安 710054 13891434043@163.com 
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中文摘要:
      目的 探讨氨甲环酸结合术后临时引流管夹闭对减少肘关节僵硬松解术出血量的有效性。方法 选择2016年3月至2019年3月于西安交通大学医学院附属红会医院行肘关节松解术的65例病人作为研究对象,随机分为静脉组(23例)、关节腔组(22例)和对照组(20例),静脉组在松止血带前5~15 min给予总量1 g氨甲环酸静脉滴注,关节腔组给予1 g氨甲环酸关节腔灌注,对照组给予等量生理盐水关节腔灌注和静脉滴注,三组术后引流管均临时夹闭4 h。记录并比较各组凝血指标(D-二聚体),出血量指标[血红蛋白(Hb)、红细胞压积、引流量和失血量],术后切口并发症,疼痛视觉模拟量表(visual analogue scale,VAS)评分,术后Mayo肘关节功能评分(Mayo elbow performance score,MEPS)和肘关节屈伸、旋转活动度。结果 三组止血带使用时间、术后第3天Hb比较,差异均无统计学意义(P均>0.05)。三组病人均未接受异体输血。三组术后第1天Hb、D-二聚体比较,差异均有统计学意义(P均<0.05);静脉组和关节腔组术后24 h引流量、总引流量、隐性失血量、总失血量、术后切口并发症发生率均显著低于对照组(P均<0.05);静脉组和关节腔组术后24、48、72 h VAS评分,术后2周、1个月、3个月肘关节MEPS评分,术后1、3个月肘关节屈伸、旋转活动度范围均优于对照组,差异均有统计学意义(P均<0.05)。结论 静脉滴注或关节腔局部应用氨甲环酸结合引流管夹闭均能有效降低术后引流量和失血量,减少术后疼痛、红肿渗出、纤溶亢进,提高功能锻炼配合度,获得更好的早期肘关节功能。
英文摘要:
      Objective To investigate whether tranexamic acid combined with temporary drainage tube clamping can reduce the amount of blood loss and obtain a better prognosis of elbow joint function. Methods A total of 65 patients who underwent elbow arthrolysis in Honghui Hospital from March 2016 to March 2019 were randomly divided into vein group (23 cases), joint cavity group (22 cases) and control group (20 cases). Intravenous infusion of 1 g tranexamic acid was given 5-15 min before tourniquet loosening in vein group, 1 g tranexamic acid was infused into articular cavity in joint cavity group, and the same amount of normal saline was given in control group. The drainage tubes of the three groups were temporarily clamped for 4 h after operation. The coagulation index (D-dimer), bleeding volume [hemoglobin (Hb), hematocrit, drainage, blood loss], postoperative incision complications, visual analogue scale (VAS), postoperative Mayo elbow performance score (MEPS) and range of flexion, extension and rotation of elbow joint were recorded and compared. Results There were no significant differences in use time of tourniquet and 72 h Hb after operation among the three groups (P>0.05). None of the three groups received allogeneic blood transfusion. There were significant differences in Hb and D-dimer among the three groups on the first day after operation (all P<0.05). The 24 h drainage volume, total drainage volume, hidden blood loss volume, total blood loss volume and the incidence of postoperative incision complications in the vein group and joint cavity group were significantly reduced as compared with those in the control group (all P<0.05). The VAS score, MEPS score at 2nd week, 1st month and 3rd month after operation, the range of elbow flexion, extension and rotation at 1st month and 3rd month after operation in vein group and joint cavity group were better than those in control group (all P<0.05). Conclusion Intravenous drip or local application of tranexamic acid combined with drainage tube can effectively reduce postoperative drainage and blood loss, alleviate postoperative pain, red and swollen exudation, hyperfibrinolysis, improve the degree of coordination of functional exercise, and obtain a better early prognosis of elbow joint function.
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