目的：探讨痛风石关节清理术后发生急性痛风性关节炎的原因、诱发因素。方法：回顾分析2010年1月至2014年12月，行痛风石关节清理术的患者临床资料，326例痛风石关节清理术的患者中有50例在一周内发生发生急性痛风性关节炎，甚至其中的36例患者发生较术前更严重的急性关节炎症状。面对这种疑惑，研究者应用全科医学的思维方法，结合后期的临床观察，分析找出50例痛风石关节清理术后急性关节炎症状、体征加重的原因。结果：痛风石关节清理术后，如果继续使用别嘌醇抑制尿酸生成，可能使手术部位或非手术部位组织内的尿酸盐结晶重新溶解，中性白细胞的趋化、黏附和吞噬作用增强；单粒细胞和中性白细胞释放PGE和白三烯增加，关节局部的红、肿、热、痛的急性期炎症反应更加明显，导致急性痛风性关节炎症状和体征，患者的关节疼痛剧烈并关节功能障碍加重。结论：运用全科医学的临床思维模式，首先在诊疗方式上不仅要依靠设备和药物,而且需要综合考虑疾病发生发展过程中涉及的多种影响因素。痛风石关节清理术后，因别嘌醇使手术部位或非手术部位关节、组织内的尿酸盐结晶重新溶解，导致急性痛风性关节炎症状和体征加重，因此术后不宜使用或继续使用别嘌醇抗痛风治疗。但秋水仙碱毒性极大，有骨髓抑制、肾脏损害等毒副作用，年老体弱者应慎用，可以酌情选用促进尿酸从肾脏排泄的药物，如苯溴马隆、丙磺舒，抑制肾小管对尿酸盐的重吸收，使尿酸盐的排泄增加，从而降低血尿酸的浓度，减少尿酸沉积。研究者认为：痛风石关节清理术后，可复查血尿酸，对于血尿酸检验值在正常范围内的术后患者，不一定要继续使用抗痛风药治疗；对于血尿酸检验值仍然高出正常参考值较多的术后患者，即使需要继续降血尿酸治疗，应考虑选用促进尿酸从肾脏排泄的药物，如苯溴马隆、丙磺舒。%Objective To explore the tophus joints, clean up the cause of postoperative acute gouty arthritis, inducing factors.Methods Retrospective analysis in January 2010 to December 2014, line tophus joint clean surgery clinical data of patients, 326 cases of joint tophus cleaning technique of 50 cases of patients with acute gouty arthritis in within a week, even one of the 36 cases of patients with more serious than preoperative acute arthritis symptoms occur. In the face of such doubts, the researchers used the way of thinking in general medicine, combining with the clinical observation of late, to analyse 50 cases tophus joints, clean up the cause of postoperative symptoms and signs of acute arthritis is aggravating.Results Tophus joint clean up, if continue to use Allopurionl inhibit acid production, may make the surgical site or non-surgical urate crystals within the organization to dissolve, neutrophil chemotaxis, adhesion and phagocytosis of reinforcement; Single granulocyte and neutrophil increased release of PGE and leukotriene, joint localized redness, swelling, heat, pain of acute inflammation is more apparent, cause signs and symptoms of acute gouty arthritis, joint pain in patients with acute aggravating and joint dysfunction.Conclusion With the model of clinical thinking of general medicine, first in terms of diagnosis and treatment way not only to rely on equipment and drugs, but also need to consider disease involved in the development process of a variety of factors. Tophi joints, clean up after, because Allopurionl make surgical site or non-surgical joints, urate crystals within the organization to dissolve, lead to acute gouty arthritis symptoms and signs is aggravating, so Allopurionl postoperative unfavorable use or continue to use alcohol resistant gout treatment. But colchicine toxicity is great, there are bone marrow suppression, kidney damage and other side effects, frail elderly should be careful, can choose to promote appropriate uric acid excretion by the kidneys of drugs, such as benzene bromide Malone, probenecid, inhibiting renal tubular reabsorption of uric acid salt, increase the excretion of uric acid salt, thereby reducing the concentration of blood uric acid, reduce uric acid deposition. Researchers think: tophus joint cleaning postoperatively, can review the blood uric acid, tests for blood uric acid values within the normal range of postoperative patients, doesn't have to continue to use anti gout drug treatment; Tests for blood uric acid values are still higher than that of normal reference value more postoperative patients, even if the need to continue to fall the blood uric acid treatment, should consider to choose promote drug of uric acid excretion by the kidneys, such as benzene bromine Malone, probenecid.
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