针对性止血应用于膝关节置换术的临床观察

Impact of intraoperative targeted electrocoagulation in TKA

目的观察术中针对性止血对节约膝关节置换术用血的临床效果。方法统计2013年1月-2014年12月,均由通信作者主刀完成的连续初次单侧人工全膝关节置换术(TKA)213例,术中通过反复多次直视下对膝上内侧动脉、膝下内侧动脉、膝下外侧动脉、胫前返动脉、后方关节囊滋养血管进行电凝止血,记录术前、术后d1、3、7,Hb、Hct、术中出血量、术后引流量、根据Gross方程计算术后d1、3、7失血量、隐性失血量;术前/术后异体输血量,输血并发症、异体输血率。结果 213名患者术中出血量(49.23±54.92)mL;术后d1引流量(58.28±11.54)mL,Hb(90.73±12.04)g/L,Hct(24.42±2.80)%,隐性失血量(111.16±11.83)mL,失血量(218.66±58.92)mL,术后d1Hb、Hct与术前比较,差异均具有统计学意义(P<0.01);术后d3 Hb(83.19±12.19)g/L,Hct(22.98±3.04)%,隐性失血量(521.10±41.22)mL,失血量(628.61±73.07)mL,术后d3 Hb、Hct隐性失血量、失血量与术后d1比较,差异均具有统计学意义(P<0.01);术后7d Hb(92.72±12.43)g/L,Hct(28.23±3.31)%,隐性失血量(402.18±46.95)mL,失血量(509.69±77.58)mL,术后d7 Hb、Hct、隐性失血量、失血量与术后d3比较,差异均具有统计学意义(P<0.01),与术后d1比较,Hb、Hct、隐性失血量、失血量差异有统计学意义(P<0.01)。结论 TKA术后d3是累计失血最多的时间点,3d后贫血状态逐渐得到纠正;TKA术中直视下针对膝上内侧动脉、膝下内侧动脉、膝下外侧动脉、胫前返动脉、后方关节囊滋养血管反复多次止血,可达到减少术后出血、输血的目的,从而避免输血、节约血源。

Objective To analyze the impact of intraoperative targeted electrocoagulation in TKA for diminishing transfu- sion and conserving blood. Methods Collecting 213 serial cases who had underwent primary TKA by corresponding author from 2013.1 to 2014.12. Medial superior artery, medial superior artery, lateral posterior tibial artery, anterior tibial artery, posterior tibial artery and posterior capsular nourish vessel were targeted electrocoagulated during operation. Hemoglobin, Hematocrit were recorded before operation, 1 st,3rd and 7th after operation, and volume of blood lost intraoperation and drain- age after surgery, while volume of blood lost was caculated according to Gross formulae and hidden blood lost was also cacu- lated. The volume of pre/post-op transfusion, the adverse reactivity and the transfusion rate was also recorded. Results The volume of intraoperative blood lost was （49.23 ±54.92）mL. Day 1 after operation：the drainage volume （5g. 28 ± 11.54） mL, Hb （90.73 ± 12. 04） g/L, Hct （24. 42 ±2. 80） %, volume of hidden blood lost （ 111.16± 11.83 ） mL and volume of blood lost（218. 66 ±58.92）mL. The difference of the all of above compared with preoperation was significant（ P 〈 0. 01 ）. Day 3 ： Hb（83.19± 12. 19）g/L,Hct（22. 98 ±3.04）% ,volume of hidden blood lost（521.10 ±41.22） mL,and volume of blood lost （628.61 ± 73.07） mL. The difference between Day 3 and Day 1 was significant （ P 〈 0. 01 ）. Day 7 ： Hb （ 92. 72±12.43 ） g/ L, Hct （28. 23 ±3. 31 ） %, volume of hidden blood lost （402. 18 ± 46. 95 ） mL, and volume of blood lost （ 509.69 ± 77.58 ） mL. All of these were difference between Day 7 and Day3, Day 7 and Day 1 （P 〈 0.01 ）. Conclusion Day 3 is the peek time of blood lost, after that anemia will be improved day by day. Diminishing bleeding was achived from tageted electrocoagulation to medial superior artery, medial superior artery, lateral posterior tibial artery, anterior tibial artery, posterior tibial artery and posterior capsular nourish vessel once and once again during TKA, so transfusion after surgery was almost avoided.