不同血红蛋白水平女性患者TKA术后间断夹闭引流的临床研究

摘要

目的：探讨术后间断夹闭引流4 h在不同血红蛋白（Hb）水平女性患者全膝关节置换（TKA）术后出血控制中的应用效果。方法选取2012年9月至2015年8月佛山市第一人民医院收治的88例行TKA手术的女性患者纳入研究，其中轻度贫血（90 g/L＜Hb≤110 g/L）和非贫血（Hb ＞110 g/L）患者各44例，按术后引流方式随机将患者分入轻度贫血持续引流组、轻度贫血间断夹闭引流组、非贫血持续引流组和非贫血间断夹闭引流组，每组各22例。其中间断夹闭引流方式是TKA术后伸直位夹闭引流2 h，开放引流5 min，再次夹闭引流2 h后开放引流至术后24 h拔除引流管。记录并比较同一Hb水平不同引流方式患者术后引流量、总失血量、隐性失血量、Hb降低值、输血率、平均输血量、膝关节活动度，以及感染、伤口皮缘坏死、皮下瘀斑等手术并发症情况。结果同一Hb水平但术后引流方式不同的患者，其在术后引流量、总失血量、隐性失血量、Hb降低值等方面，差异有统计学意义（P＜0.05）；在平均输血量方面，轻度贫血患者两组之间差异有统计学意义（P＜0.05），但非贫血患者两组之间差异无统计学意义（P＜0.05）；比较同一Hb水平患者组间输血率、膝关节活动度、皮下瘀斑发生率及肢体肿胀程度，差异无统计学意义（P＞0.05）。所有患者术后均无感染及伤口皮缘坏死发生。结论与常规持续引流相比，TKA术后间断夹闭引流4 h能有效减少女性患者术后引流量、总失血量、隐性失血量及Hb降低值，对轻度贫血患者的平均输血量也有明显的降低作用；输血率在TKA术后出血评价中的应用有一定局限性，平均输血量比输血率更适合作为TKA术后出血评价的指标。%Objective To study the effects of intermittent clamping drainage (ICD) for 4 hours after total knee arthroplasty (TKA) in the female patients with different hemoglobin (Hb) levels. Methods A total of 88 female patients who received TKA in the First People's Hospital of Foshan from September 2012 to August 2015 were selected. There were 44 patients with mild anemia (90 g/L110 g/L) in this study, then they were further divided into continuous drainage and ICD groups randomly, thus there were 4 groups subsequently, group A (90 g/L110 g/L, continuous drainage) and group D (Hb>110 g/L, ICD). ICD method was to clamp all time but 5 min every 2 h for the first 4 h after TKA with the affected limb at extension position, then open the drainage until it was removed 24 h after the operation. Postoperative drainage volume, total hemorrhage volume, hidden hemorrhage volume, calculated Hb loss, blood transfusion rate, average volume of blood transfusion, range of motion (ROM) of knee joint and surgical complications such as infection, skin necrosis of wounds, ecchymosis were recorded and compared among the groups. Results For patients with the same Hb levels, differences of postoperative drainage volume, total hemorrhage volume, hidden hemorrhage volume and calculated Hb loss had statistical significance between different drainage groups (P <0.05); But their blood transfusion rate, ROM of knee joint, incidence of ecchymosis and limb swelling showed no statistical differences (P>0.05). For average blood transfusion volume, there were statistical differences between continuous drainage and ICD groups of patients with mild anemia (P <0.05), while there was no statistical differences for non-anemic patients (P >0.05). No infection or skin necrosis of wounds happened in all groups. Conclusions Compared to the routine continuous drainage, four hours' intermittent clamping drainage after TKA could reduce postoperative drainage volume, total hemorrhage volume, hidden hemorrhage volume and calculated Hb loss effectively, and lower average blood transfusion volume obviously for mild anemia patients. Due to the limitation of blood transfusion rate, average volume of blood transfusion seems to be more suitable indicator in evaluation of hemorrhage after TKA.