控制性降压对全膝关节置换术血液丢失及骨水泥渗透厚度的影响

Effects of Controlled Hypotension on Blood Loss and Bone Cement Penetration Thickness in Total Knee Arthroplasty

目的 比较控制性降压和止血带下行全膝关节置换术后血液丢失情况及骨水泥渗透厚度。方法 回顾性收集蚌埠医学院附属阜阳医院(阜阳市人民医院)2020年1月至2022年12月在气静复合麻醉下行单侧全膝关节置换术患者168例。按照术中止血方式不同,分为控制性降压组和止血带组,控制性降压组61例,其中男17例,女44例;年龄55~80岁,平均(67.26±5.56)岁。止血带组107例,其中男28例,女79例;年龄55~80岁,平均(67.70±5.81)岁。两组患者性别、年龄、身高、体重、身体质量指数等一般资料以及术前血红蛋白、术前红细胞压积等资料比较,差异均无统计学意义(P>0.05),比较两组患者血液丢失方面数据、手术时长、胫骨假体周围骨水泥渗透厚度的差异。结果 两组手术时长、显性失血量、胫骨假体周围骨水泥渗透厚度的比较,差异无统计学意义(P>0.05),两组血红蛋白下降量、红细胞压积下降量、术中出血量、术后引流量、隐性失血量、总失血量的比较,差异有统计学意义(P<0.05)。结论 在全膝关节置换术中,与术中使用止血带相比,使用控制性降压可降低患者隐性失血量、总失血量,且不增加手术时长,不影响胫骨假体周围骨水泥渗透厚度。

Objective To compare the blood loss and bone cement penetration thickness after total knee arthroplasty under controlled hypotension and tourniquet.Methods retrospective study was conducted to collect 168 patients in the Fuyang Hospital Affiliated to Bengbu Medical College.The patients underwent unilateral total knee arthroplasty under general anesthesia from January 2020 to December 2022.According to different methods of intraoperative hemostasis,they were divided into a controlled hypotension group and a tourniquet group.The controlled hypotension group had 61 cases.Among them,there were 17 males and 44 females.The patients aged 55 to 80 years,with an average age of(67.26±5.56)years.The tourniquet group had 107 cases.Among them,there were 28 males and 79 females.The patients aged 55~80 years,with an average age of(67.70±5.81)years.There was no statistically significant difference between the two groups in general information such as gender,age,height,weight,body mass index,and preoperative hemoglobin and hematocrit(P>0.05).The differences in blood loss data,surgical time,and bone cement infiltration thickness around the tibial prosthesis were compared between the two groups.Results There was no statistically significant difference between the two groups in surgical time,dominant blood loss,and bone cement infiltration thickness around the tibial prosthesis(P>0.05).There was a statistically significant difference between the two groups in hemoglobin reduction,hematocrit reduction,intraoperative bleeding,postoperative drainage,hidden blood loss,and total blood loss(P<0.05).Conclusion Compared to using a tourniquet during surgery,the use of controlled hypotension can reduce the patient's hidden blood loss and total blood loss,without increasing the surgical duration,and without affecting the bone cement penetration thickness around the tibial prosthesis in total knee arthroplasty.