不同止血带使用方法对TKA围手术期失血量影响的临床研究

Effect of different usages of tourniquet on perioperative blood loss in total knee arthroplasty

目的研究人工全膝关节置换术(TKA)中两种不同止血带使用方法对围手术失血总量的影响。方法选取2009年1月至2010年6月60例60～75岁单侧TKA患者进行研究,随机分成A组(30例,术中采用截骨完成后使用止血带至手术结束)和B组(30例,术中采用全程在止血带下完成手术),所有手术均由同一组医师完成,比较A、B两组患者围手术期总失血量、显性出血量、隐性失血量、输血比例、输血量及手术时间的差异。结果 A组在显性失血量、手术时间较B组明显增加,差异有统计学意义(P<0.05);而在围手术期总失血量、隐性失血量、输血比例、输血量A组较B组明显减少,差异有统计学意义(P<0.05)。结论在TKA手术当中截骨完成后开始使用止血带的方法,是一种能够明显减少围手术期总失血量、降低输血比例及输血量的新手术方式,同时减少了手术后并发症的发生率。

Objective To study the effect of two different usages of tourniquet on perioperative blood loss in total knee arthroplasty（TKA）.Methods From January 2009 to June 2010,60 patients,aged from 60 to 75 years,were treated with unilateral TKA by the same group of surgeons.They were randomly divided into two groups：in group A,30 patients used the tourniquet just after finishing the osteotomy;in group B,30 patients used the tourniquet in the whole procedure.The perioperative total blood loss,visible blood loss,hidden blood loss and transfusion rate and volume of the two groups were compared.Results Compared with group B,visible blood loss and operative time in group A significantly increased（P〈0.05）.However,total blood loss,hidden blood loss and transfusion rate and volume in group A were much less than those in group B（P〈0.05）.Conclusion The usage of tourniquet after osteotomy in TKA can obviously reduce the perioperative total blood loss,transfusion rate and volume as well as the rate of postoperative complication.