全膝关节置换术后不同切口引流管夹闭时间对失血及并发症的影响

Effects of different drainage tube clamping time after total knee arthroplasty on blood loss and compilations

目的探讨全膝关节置换术后氨甲环酸关节腔内注射不同引流管夹闭时间对术后失血及并发症的影响。方法采用连续抽样的方法，选取2016年10月一2017年2月在北京市某三级甲等医院行全膝关节置换术患者93例，根据引流管夹闭时间随机分为3组，夹闭2h组33例、夹闭4h组29例、夹闭6h组31例。测量患者术后24h切口引流量、术后较术前血红蛋白下降水平；术后打开切口切口引流管时髌骨周径，术后返病房即刻、术后2、4、6h疼痛评分及术后第1～3天最高体温。结果在切口引流量方面，夹闭4h组和6h组低于夹闭2h组，差异有统计学意义（P〈0．05）；在髌骨周径和疼痛方面，夹闭6h组高于夹闭2h组和4h组，差异有统计学意义（P〈0．05）；3组患者血红蛋白下降和最高体温比较，差异无统计学意义（P〉0．05）。结论全膝关节置换术后引流管夹闭4h可有效减少切口引流量，不增加膝关节肿胀、疼痛和术后吸收热。

Objective To evaluate the effects of intra-articular injection of tranexamic acid with different drainage tube clamping time on blood loss and complications after total knee arthroplasty. Methods A total of 93 patients undergoing total knee arthroplasty from Octorber 2016 to February 2017 in a Class 3 Grade A hospital in Beijing were selected by continuous sampling method. All the research subjects were divided according to the drainage tube clamping time into three groups： clamping 2 h group （n=33）, 4 h group （n=29） and 6 h group （n=31）. The 24 h postoperative wound drainage, hemoglobin decrease, knee girth, VAS and temperature postoperatively were observed. Results There were significant differences in the wound drainage among the three groups （P 〈 0.05）. The knee girth and VAS of the 6 h group were higher than those of the 2 h and 4 h group, and the differences were statistically significant （P 〈 0.05）. There were no significant differences among the three groups in hemoglobin decrease and temperature （P 〉 0.05）. Conclusions Clamping drainage tube for 4 h after total knee arthroplasty can effectively reduce wound drainage, and will not increase the knee hematoma, pain and postoperative fever.