摘要
目的探讨TKA术中气囊止血带不同应用时机对出血量的影响，以期为临床应用提供依据。方法回顾性分析2012年1月～2015年6月接受单侧全膝关节置换术治疗的患者87例的临床资料，根据术中止血带应用时机的不同分为Ⅰ组，Ⅱ组和Ⅲ组。Ⅰ组气囊止血带在术前使用。在关闭切口前释放，然后止血、关闭切口、加压包扎；Ⅱ组在术前使用，在术毕加压包扎后释放；Ⅲ组在完成截骨后使用，至加压包扎后释放。比较三组术中出血量、总失血量、止血带应用时间，术后患者深静脉血栓以及肌间血栓形成的发生率，比较术后切口愈合情况，术后患者气囊止血带部位皮肤损伤情况。结果Ⅱ组术中出血量最少，Ⅲ组术后出血量和隐性出血量以及总失血量均最低，三组间比较，差异有高度统计学意义（P〈0．01）。Ⅰ组和Ⅱ组平均止血带使用时间均显著长于Ⅲ组（P〈0．01）。三组术后皮肤损伤情况比较，差异有统计学意义（P〈0．01）。三组深静脉血栓形成率比较差异无统计学意义（P〉0．05）；Ⅲ组肌间血栓形成率最低，其次为Ⅰ组，Ⅱ组最高，差异有高度统计学意义（P〈0．01）；Ⅰ组和Ⅱ组刀口红肿时间均显著长于Ⅲ组，差异有高度统计学意义（P〈0．01）。结论TKA手术中，在截骨完成后使用气囊加压止血带，在术后加压包扎后释放止血带，能够显著减少总失血量，减少术后并发症的发生，有利于患者的恢复。
Objective To discuss effect on bleeding and skin complications of different timing of the application of tourniquet in TKA, in order to provide base for clinical application. Methods Clinical data of 87 cases with TKA from Jan 2012 to Jun 2015 were respectively analyzed. All case were divided into group Ⅰ , Ⅱ and Ⅲ according to different timing of the application of tourniquet. In group Ⅰ, tourniquet was used before operation, and was dismiss before close- ing incision, then for hemostasis, wound closure and bandaged. In group Ⅱ, tourniquet was used before operation, and was dismiss after bandaged. In group Ⅲ, tourniquet was used after completion of the osteotomy, and was dismiss after bandaged. Blood loss in operation, the total blood loss, tourniquet time, DVT, myenteric thrombosis, wound healing and skin complications of three groups were compared. Results Compared in three groups, blood loss in operation of group H was lest, and postoperative bleeding, recessive bleeding and total bleeding of group Ⅲ were lest, which showed sig nificant difference in three groups（P〈0.01）. Tourniquet time of group Ⅰ and group Ⅱ was longer than group Ⅲ （P〈0.01）. Skin complications of three groups showed significant difference （P〈0.01）. DVT rate of three groups showed no signifi cant difference（P〉0.05）. Myenteric thrombosis rate of group Ⅲ was lowest, followed by group Ⅰ , and group Ⅱ was highest（P〈0.01）. Edge swelling time of group Ⅰ and group Ⅱ was longer than group In （P〈0.01）. Condusion In TKA, to use tourniquet after completion of the osteotomy, and dismiss after bandaged, can reduce total blood loss and complications after operation, and which is conducive to patient recovery.
出处
《中国现代医生》
2015年第31期1-4,共4页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2011ZHA006)
