术中脉冲冲洗对膝关节置换术后自体血回输的影响

Application study on pulse irrigation combined with autologous blood transfusion in total knee arthroplasty

目的:观察术中脉冲冲洗联合术后自体血回输,对膝关节置换手术凝血、炎症、血栓指标的影响,并与单用术后自体血回输的对照组进行比较。方法:选取因膝关节骨性关节炎行单侧人工全膝关节置换术患者96例,随机分成实验组(术中脉冲冲洗联合术后自体血回输)和对照组(单用术后自体血回输组),检测对比不同时点两组的PT、APTT、TNF-α、IL-6、D-D值,并术后行下肢血管彩超检查。结果:两组患者术后的PT、APTT值比较差异无统计学意义(P>0.05),实验组术后第1、7天的TNF-α、IL-6值均低于对照组,差异有统计学意义(P<0.05),实验组术后第4天的D-D值均低于对照组,差异有统计学意义(P<0.05),实验组下肢DVT的发生率低于对照组(P<0.05)。结论:全膝关节置换术中脉冲冲洗联合术后自体血回输对凝血功能无影响,且较单用自体血回输可以减轻炎症、减少深静脉血栓的发生,故对患者恢复有益。

Objective To explore the effect of pulse irrigation combined with autologous blood transfusion on inflammatory markers and thrombosis index, such as C-reactive protein（CPR）, erythrocyte sedimentation rate（ESR）, tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） in patients undergoing total knee arthroplasty.Methods 96 patients due to knee osteoarthritis underwent unilateral total knee arthroplasty were randomly divided into experimental group（pulse irrigation combined with autologous blood transfusion after surgery） and control group（alone autologous blood transfusion after surgery）, PT, APTT, TNF-α, IL-6, D-Dimer of two groups at different time points were detected and compared. All patients underwent lower extremity vascular ultrasound examination after operation. Results PT, APTT values were no significant different between two groups（P〉0.05）, TNF-α, IL-6 values of day1 and day7 after surgery in the experimental group were lower than the control group（P〈0.05）, D-Dimer values of day4 after surgery were lower than the control group（P〈0.05）, the incidence of deep vein thrombosis（DVT） in the experimental group was lower than the control group（P〈0.05）. Conclusion Pulse irrigation combined with postoperative autologous blood transfusion in total knee arthroplasty had no influence in blood coagulation, and can reduce inflammation and the incidence of DVT than alone autologous blood transfusion,thus is beneficial to the patient recover.