摘要
目的:比较常压转负压引流和夹闭后转负压引流2种引流方式对全膝关节置换(total knee arthroplasty,TKA)术后引流量和失血量的影响。方法:回顾性分析2014年1月1日至2015年3月1日,在浙江省中医院接受初次单侧TKA的94例患者的病例资料。术中植入引流管后,44例患者采用常压引流12 h再转成负压引流(常压转负压引流组),50例患者采用夹闭引流管4 h后打开引流管持续负压引流(夹闭后转负压引流组)。均在24 h引流量<50 m L时拔管。比较2组患者的引流时间、术后各时间段(0~6 h、>6~12 h、>12~24 h、>24 h)引流量、总引流量及术后24 h总失血量。结果:术后不同时间段引流量的差异有统计学意义,即存在时间效应(F=53.491,P=0.000)。2组患者术后6~12 h引流量均达到高峰。2组患者术后引流量总体比较,差异有统计学意义,即存在分组效应(F=212.801,P=0.000)。术后各个时间段,常压转负压引流组引流量均低于夹闭后转负压引流组[(40.34±32.63)m L,(86.10±66.65)m L,t=-4.137,P=0.000;(59.55±26.80)m L,(145.72±59.51)m L,t=-8.844,P=0.000;(36.71±16.60)m L,(103.80±35.06)m L,t=-11.597,P=0.000;(18.75±8.70)m L,(40.16±17.45)m L,t=-7.370,P=0.000]。时间因素和分组因素存在交互效应(F=11.538,P=0.000)。2组患者引流时间的组间差异无统计学意义[(38.70±7.23)h,(37.74±0.81)h;t=0.933,P=0.590],但常压转负压引流组术后总引流量和术后24 h总失血量均较夹闭后转负压引流组少[(155.34±48.80)m L,(375.78±89.13)m L,t=-15.104,P=0.000;(692.52±258.72)m L,(843.25±310.11)m L;t=-2.031,P=0.045]。结论:初次单侧TKA术后,采用常压转负压引流和夹闭后转负压引流2种引流方式,引流时间相当,但前者的术后引流量和术后24 h总失血量均小于后者。
Objective：To compare the effects of negative - pressure drainage following normal - pressure drainage versus negative - pressure drainage following closing drainage tube on volume of drainage and blood loss after total knee arthroplasty（TKA）. Methods ：The medical records of 94 patients who received primary unilateral TKA in Zhejiang Provincial Hospital of Traditional Chinese Medicine from 1 January 2014 to 1 March 2015 were analyzed retrospectively. After intraoperative implantation of drainage tube ,44 patients were treared with negative -pressure drainage following 12 -hour normal -pressure drainage（ group A） ,while 50 patients were treated with negative -pressure drainage following closing drainage tube for 4 hours（ group B）. The drainage tubes were removed when the volume of 24 - hour drainage was of 〈 50 mL. The drainage time, volume of drainage at different postoperative time periods （0 - 6 hrs, 〉 6 - 12 hrs, 〉 12 - 24 hrs, 〉 24 hrs）, total volume of drainage and total postoperative 24 -hour blood loss were compared between the 2 groups. Results：There was sta- tistical difference in volume of drainage between different postoperative timeperiods,in other words, there was time effect（ F = 53. 491 ,P = 0.000）. The volume of drainage peaked at 6 - 12 hours after the surgery in both of the 2 groups. There was statistical difference in postoperative volume of drainage between the 2 groups in general,in other words, there was group effect（ F = 212. 801, P = 0.000）. The volume of drainage was less in group A compared to group B in all postoperative timeperiods（40.34 ＋/- 32.63 vs 86.10 ＋/- 66.65 mL, 4. 137,P =0.000;59.55 ＋/-26.80 vs 145.72 ＋/-59.51 mL,t 11. 597,P =0.000;18.75 ＋/-8.70 vs40.16 ＋/-17.45 mL,t = - 8. 844, P = 0.000 ; 36.71 ＋/- 16.60 vs 103.80 ＋/- 35.06 mL, 7. 370, P = 0.000）. There was interaction between time factor and group factor（ F = 11. 538,P = 0. 000）. There was no statistical difference in drainage time between the 2 groups（38.70 ＋/-7.23 vs 37.74 ＋/-0.81 hrs, t = 0. 933,P = 0.590） ,while postoperative total volume of drainage and postoperative total 24 - hour blood loss were less in group A compared to group B （ 155.34 ＋/- 48.80 vs 375.78 ＋/- 89. 13 mL, t = - 15. 104, P = 0. 000; 692.52 ＋/- 258.72 vs 843.25 ＋/- 310.11 mL, t = - 2.031, P = 0.045 ）. Conclusion ： Negative - pressure drainage following normal - pressure drainage is sinfilar to negative- pressure drainage following closing drainage tube in drainage time after primary unilateral TKA, however, the former has the advantages of less postoperative volume of drainage and less postoperative 24 - hour blood loss compared to the latter.
作者
张津杰
郑嘉晖
严世贵
ZHANG Jinjie;ZHENG Jiahui;YAN Shigui(Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China;Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China;The Second Affiliated Hospital of Medical School of Zhejiang University,Hangzhou 310009,Zhejiang,China)
出处
《中医正骨》
2018年第7期14-16,24,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
关节成形术
置换
膝
引流术
手术后出血
arthroplasty
replacement
knee
drainage
postoperative hemorrhage
