加压局部物理降温对全膝关节置换术后失血控制的效果观察

An observation of compressive cryotherapy on blood loss control after total knee arthroplasty

目的评价加压局部物理降温在全膝关节置换术后失血控制中应用的临床效果。方法选择50例单侧全膝关节置换术后患者为研究对象，按照随机数字表法分为干预组和对照组，每组25例。干预组患者膝关节置换后采用加压循环冷疗系统行膝关节处持续降温，维持48h。对照组术后给予常规护理。动态监测2组患者术后6、8、24、48h引流量，连续复查2组患者24、48、72h血红蛋白及红细胞压积。测量2组患者术后24、48h肢体周径变化，并统计72h的美国膝关节协会评分（KSS）。结果干预组术后6、8、24、48h失血量分别为（198．12±8．88）、（250．00±10．89）、（301．00±15．44）、（358．04±11．60）ml，对照组分别为（249．88±9．21）、（302．60±11．61）、（369．12±13．20）、（450．40±12．71）ml，2组比较差异有统计学意义（t=16．518～26．836，P〈0．05）；术后24、48、72h干预组血红蛋白值分别为（130．1±16．3）、（117．5±14．5）、（115．0±12．7）g／L，对照组分别为（119．9±13．8）、（106．7±15．7）、（108．6±8．6）gm，差异有统计学意义（t=2．07、2．37、2．52，P〈0．05）；术后24、48h干预组红细胞压积较对照组高（t=2．09，2．54，P〈0．05）；术后24、48h膝上、膝下的肢体肿胀程度干预组较对照组轻（膝上t=2．63、3．04，P〈0．05，膝下t=6．29、12．03，P〈0．05）；2组患者术后早期72h的KSS评分比较差异无统计学意义（P〉0．05）。结论全膝关节置换术后应用加压局部物理降温，可有效减少出血量，减轻患肢局部肿胀，利于患者术后恢复及关节功能康复。

Objective To evaluate the efficacy of compressive eryotherapy on blood-loss control after total knee arthroplasty （TKA）. Methods Fifty patients undergoing unilateral TKA were randomized into cryotherapy group and controlled group postoperatively. Patients in the cryotherapy group were treated with Iceman model 2200 cold therapy unit on the knee for 48 hours. The drainage volume of both groups was measured dynamically for 6 hours, 8 hours, 24 hours, 48 hours after the TKA. The hemoglobin and hematocrit were continuously followed up for 24 hours, 48 hours and 72 hours. The limb circumference was measured for 24 hours and 48 hours after the TKA. Postoperative 72-hour American Knee Society Score （KSS） was calculated. Results The hemorrhage volume of cryotherapy group was （198.12±8.88）, （250.00± 10.89）, （301.00± 15.44）, （358.04± 11.60） ml separately for 6 hours, 8 hours, 24 hours, 48 hours after the TKA and （249.88±9.21）, （302.60± 11.61）, （369.12± 13.20）, （450.40±12.71） ml in the controlled group, （t=16.518-26.836, P〈0.05） there was significant difference. The hemoglobin value of cryotherapy group was （130.1 ±16.3）, （117.5± 14.5）, （115.0±12.7） g/L separately for 24 hours, 48 hours, 72 hours, after the TKA and （119.9± 13.8）, （106.7 ± 15.7）, （108.6± 8.6） g/L in the controlled group, there was signifieant difference （t=2.07, 2.37, 2.52, P〈0.05）. The postoperative 24h and 48h values of hemoglobin and hematocrit were greater in the cryotherapy group than that in the controlled group （t=2.09, 2.54, P〈 0.05）. The postoperative 24h and 48h edema （shown as limb eireumference increase） was lighter in the cryotherapy group （above the knee t=2.63, 3.04, P〈0.05, below the knee t=6.29, 12.03, P〈0.05）. Theseresults were all statistically significant （P〈0.05）. The 72 h KSS values showed no differences in the two groups （P 〉 0.05）. Conclusions Compressive cryotherapy after TKA is effective in reducing blood loss and edema, which is beneficial to early recovery and functional rehabilitation.