止血带对全膝关节置换术后深静脉血栓形成的影响

Effect of tourniquet on deep venous thrombosis after total knee arthroplasty

目的探讨止血带对全膝关节置换术后深静脉血栓形成的影响。方法采用随机对照研究，将连续入院的拟行初次全膝关节置换的80例患者随机分为两组：一组使用止血带（止血带组，40例），一组不使用止血带（非止血带组，40例）。全部采用后十字韧带替代型骨水泥固定人工膝关节（Smith—Nephew），手术由同一组医生完成。比较两组患者围手术期失血量、深静脉血栓和肺动脉栓塞发生率、术中栓子面积百分率％Ae（即总栓子面积占右心房面积的百分率）。术前及术后第1-10天行彩色多普勒超声检查，观察双下肢深静脉血栓的发生；术中使用经食道超声心动图监测右心房，评估止血带释放后的％Ae。结果止血带组患者术中失血量小于非止血带组患者，但两组患者围手术期总失血量比较差异无统计学意义。止血带组患者和非止血带组患者深静脉血栓发生率比较无统计学差异，两组均未发生肺动脉栓塞。止血带组患者％Ae在释放止血带后的1min达到高峰；非止血带组患者％Ae仅在扩髓和植入假体时出现高峰，然后缓慢下降；止血带组患者％Ae在释放止血带后大于非止血带组患者。结论止血带的使用对全膝关节置换术围手术期总失血量并无明显影响，不增加深静脉血栓和肺栓塞的发生风险。

Objective To determine the effect of tourniquet on deep venous thrombosis after total knee arthroplasty. Methods Eighty patients were prospectively randomized into 2 groups： Group A （40 patients） underwent the operation with a tourniquet, and Group B （40 patients） underwent the operation without a tourniquet. Blood loss, the rate of deep vein thrombosis （DVT） and pulmonary embolism （PE）, and the area of embolus （%Ae, total embolus area/total right atrium area） was evaluated. DVT was detected using Doppler ultrasound preoperatively and 1-10 days after the operation, and the area of embolus was evaluated by transesophageal echocardiography （TEE） during the operation. Results There was no significant difference in total blood loss between the two groups although the intraoperative blood loss in the group A was significant less than those of in the group B. There was no significant difference in the incidence of postoperative DVT between the two groups. No PE was detected in the two groups. The area of embolus in group A rose to peak in 1 minute after the release of tourniquet, while it rose to peak when the procedure of reaming and prosthesis implanting was performed, and then decrease slowly in group B. But the area of emholus was always higher in group A after release of tourniquet compared with that of group B. Conclusion Using tourniquet has no significant effect on perioperative total blood loss during total knee arthroplasty, and can not increase the risk of DVT and PE after total knee arthroplasty.