冰敷干预可抑制人工全膝关节置换后血红蛋白降低及疼痛

Ice intervention inhibits hemoglobin decrease and pain after total knee replacement

背景:减少人工全膝关节置换后出血量与血红蛋白降低量成为骨关节科临床研究的重要课题。当前冰敷疗法已被广泛应用于临床上由于各种理化原因导致的局部组织肿胀的消肿、止痛等的常规治疗中。目的:调查人工全膝关节置换后血红蛋白降低的危险因素,探讨冰敷干预应用的效果。方法:骨性关节炎患者240例根据随机抽签原则分为治疗组与对照组各120例,对两组的基本信息、疾病状况、诊治情况与预后情况都进行了调查。对照组积极给予人工全膝关节置换;在此基础上治疗组在置换后2 h开始冰敷治疗,连续7 d。结果与结论:置换后7 d,240例患者置换后发生血红蛋白降低者为34例,发生率为14.2%。多元回归Logistic分析结果显示,患者年龄、未冰敷处理、体质量指数是导致人工全膝关节置换后血红蛋白降低的危险因素(P<0.05)。与对照组相比,治疗组置换后的血红蛋白值明显升高(P<0.05),血红蛋白降低值、总失血量、输血率、输血量、置换后第3,7天的疼痛评分均显著降低(P<0.05)。治疗组的膝关节功能优良率为96.7%,对照组为95.8%,两组差异无显著性意义(P>0.05)。结果证实,人工全膝关节置换在临床上的应用能促进骨性关节炎患者的膝关节恢复,但是存在血红蛋白大幅度下降与出血的危险,积极地置换后冰敷干预降低危险,并且缓解置换后疼痛。

BACKGROUND： To reduce the amount of bleeding and the amount of hemoglobin after total knee replacement has been a key project in the clinical research in the division of bone and joint. Currently, ice therapy has been widely used in the clinic for tissue swelling and pain due to various physical and chemical factors. OBJECTIVE： To investigate the risk factors of postoperative hemoglobin after total knee replacement and discuss the effects of ice intervention. METHODS： 240 patients with osteoarthritis based on the random draw principles were equally divided into the treatment group and the control group. The general information, disease status, diagnosis and treatment and prognosis of the two groups were investigated. All patients were actively subjected to artificial total knee replacement. On the basis of the treatment in the control group, the treatment group received ice intervention at 2 hours after replacement for 7 consecutive days.RESULTS AND CONCLUSION： The postoperative hemoglobin decrease occurred in 34 patients, with the incidence of 14.2% among 240 patients at 7 days after replacement. Multivariate logistic regression analysis results showed that age, no ice treatment, body mass index were the main risk factors for hemoglobin decrease after total knee replacement（P〈0.05）. Compared with the control group, the postoperative hemoglobin values of the treatment group were significantly higher（P〈0.05）. Hemoglobin decrease values, total blood loss, blood transfusion rate, blood transfusion amount, and pain score at 3 and 7 days after replacement were significantly lower in the treatment group than in the control group（P〈0.05）. The knee function excellent and good rate was 96.7% in the treatment group, and 95.8% in the control group, which showed no significant difference（P〉0.05）. Results verify that clinical application of total knee replacement facilitated the knee recovery in patients with osteoarthritis, but hemoglobin decrease and bleeding existed. Active ice intervention can reduce the risk and relieve postoperative pain.