初次全膝关节置换术后引流管夹闭时间选择与隐性失血量的相关性研究

Relationship between the duration of temporary closure of the drainage tube and hidden blood loss after primary total knee arthroplasty

[目的]研究人工全膝关节置换术（total knee arthroplasty，TKA）后引流管夹闭时间选择对术后隐性失血量的影响。[方法]随机选取2011年5月～2013年1月在本院行初次人工全膝关节置换术患者120例，并将其随机分为4组（不夹闭组，夹闭1h组，夹闭2h组，夹闭4h组），每组各30例，分别记录术后总引流量，围手术期m细胞比容，并对隐性失血量进行统计学分析。[结果]对四组数据进行统计学分析比较，在平均总失血量、显性失m量及隐性失血量所占比例上有显著差异（P〈0．05），而在隐性失血量方面无明显差异（P〉0．05）。夹闭4h组关节肿胀和皮下瘀斑发生率增加。[结论]引流管夹闭时间对隐性失血量无明显影响，夹管2h为TKA术后引流管夹闭时间的较理想的选择，但应格外注意隐性失血的存在。

[Objective] In the present study, we aimed to analyze the effect of the duration of temporary closure of the drainage tube after primary total knee arthroplasty on hidden blood loss. [ Methods] We randomly selected 120 patients who underwent primary total knee arthroplasty in our hospital from May 2011 to January 2013. The palients were randomly divided in- to 4 groups according to whether the drainage tube was temporarily closed and the duration of closure （ the no clipping group as well as the 1 h, 2 h, and 4 h clipping groups） ; each group included 30 patients. The postoperative total drainage volume and postoperative hematocrit in the perioperative period were recorded, and the amount of hidden blood loss was statistically ana- lyzed. [ Results] Statistical analysis indicated that the total blood loss, dominant blood loss, and the percentage of hidden blood loss significantly differed among the 4 groups （P 〈 0. 05 ） ; however, no significant difference in the amount of hidden blood loss was noted （P 〉 0. 05 ） . The incidence of joint swelling and subcutaneous ecchymosis was increased in the 4 h clip- ping group. [ Conclusion] The duration of drainage tube clipping has no apparent effect on the hidden blood loss. A duration of 2 h is optimal for drainage tube clipping for primary total knee arthroplasty. However, the amount of tlidden blood loss should be carefully considered.