摘要
背景:不使用止血带行全膝关节置换可以减少围术期总失血量。而诊断为类风湿关节炎的患者在行全膝关节置换术中不使用止血带会影响围术期出血量,尤其是隐性失血。目的:探讨止血带对类风湿关节炎患者在全膝关节置换围术期失血量的影响。方法:回顾分析2016年1月至2021年12月在上海市光华中西医结合医院关节外科行单侧全膝关节置换的类风湿关节炎患者80例作为研究对象,所有患者均在全麻下行全膝关节置换,试验组39例患者全程不使用止血带,对照组41例患者全程使用止血带。记录并比较两组患者总失血量、术中出血量、显性失血量、隐性失血量、隐性失血百分比、术后输血率、手术时间、术后3 d膝关节肿胀度、术后换药次数及切口延迟愈合率。结果与结论:①试验组术后隐性失血百分比均低于对照组,差异有显著性意义(P<0.05);试验组术中出血量、手术时间均大于对照组,差异有显著性意义(P<0.05);两组围术期总失血量、隐性失血量、显性失血量、输血率比较,差异均无显著性意义(P>0.05);②试验组术后3 d膝关节肿胀度小于对照组,差异有显著性意义(P<0.05);两组术后换药次数、切口延迟愈合例数相比差异均无显著性意义(P>0.05);③提示类风湿关节炎患者在全膝关节置换过程中全程不使用止血带,不会增加围术期总失血量、隐性失血量,且可以减少术后肢体肿胀的发生。
BACKGROUND:Without using a tourniquet in total knee arthroplasty can decrease perioperative blood loss.However,patients diagnosed with rheumatoid arthritis may affect the perioperative blood loss in total knee arthroplasty,especially in hidden blood loss.OBJECTIVE:To evaluate the effect of tourniquet in patients with rheumatoid arthritis on perioperative blood loss in total knee arthroplasty.METHODS:The clinical data of 80 patients diagnosed with rheumatoid arthritis undergoing unilateral total knee arthroplasty between January 2016 and December 2021 in the Department of Joint Surgery of Shanghai Guanghua Hospital of Integrated Chinese and Western Medicine were retrospectively analyzed.All patients underwent total knee arthroplasty under general anesthesia;41 patients(control group)received total knee arthroplasty with a tourniquet while 39 patients(trial group)received total knee arthroplasty without a tourniquet.The total blood loss,intraoperative blood loss,overt blood loss,hidden blood loss,percentage of hidden blood loss,blood transfusion rate,operation time,limb swelling ratio at postoperative 3 days,wound dressing changing frequency,and delayed incision healing were recorded and compared between the two groups.RESULTS AND CONCLUSION:(1)The percentage of hidden blood loss was significantly lower in the trial group than that in the control group(P<0.05).The intraoperative blood loss and operation time in the trial group were significantly higher than those in the control group(P<0.05).There were no significant differences in total blood loss,hidden blood loss,overt blood loss,or transfusion rate between two groups(P>0.05).(2)The postoperative limb swelling ratio in the trial group was significantly lower than that in the control group(P<0.05).There were no significant differences in wound dressing changing frequency or delayed incision healing between the two groups(P>0.05).(3)It is indicated that without using a tourniquet in patients with rheumatoid arthritis undergoing total knee arthroplasty does not increase the perioperative blood loss or hidden blood loss,and also decreases the postoperative limb swelling.
作者
王浩
马成豪
覃祚海
周海波
丁皓原
韩大鹏
聂智兴
潘培军
高晨鑫
欧阳桂林
Wang Hao;Ma Chenghao;Qin Zuohai;Zhou Haibo;Ding Haoyuan;Han Dapeng;Nie Zhixing;Pan Peijun;Gao Chenxin;Ouyang Guilin(Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200050,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第31期4943-4948,共6页
Chinese Journal of Tissue Engineering Research
基金
上海市长宁区卫生健康委员会医学重点(特色)专科计划(20191003),项目负责人:欧阳桂林。
关键词
全膝关节置换
止血带
类风湿关节炎
围术期失血
隐性失血
膝关节
total knee arthroplasty
tourniquet
rheumatoid arthritis
perioperative blood loss
hidden blood loss
knee joint
作者简介
第一作者:王浩,男,1997年生,上海市人,上海中医药大学在读硕士,主要从事骨与关节疾病方面的研究。https://orcid.org/0000-0002-6330-5667;通讯作者:欧阳桂林,博士,主任医师,硕士生导师,上海中医药大学附属光华医院,上海市200052。
