| 朱慧新,戴丽群,黄秀芬,郭婧雅,方善鸿.全膝关节置换术中不同止血带使用方法的疗效比较及对患者凝血功能、炎症反应和生活质量的影响[J].,2023,(4):729-732 |
| 全膝关节置换术中不同止血带使用方法的疗效比较及对患者凝血功能、炎症反应和生活质量的影响 |
| Comparison of the Efficacy of Different Tourniquet Application Methods in Total Knee Arthroplasty and its Influence on Coagulation Function, Inflammatory Response and Quality of Life of Patients |
| 投稿时间：2022-08-10 修订日期：2022-08-30 |
| DOI：10.13241/j.cnki.pmb.2023.04.025 |
| 中文关键词: 全膝关节置换术 止血带 疗效 凝血功能 炎症反应 生活质量 |
| 英文关键词: Total knee arthroplasty Tourniquet Efficacy Coagulation function Inflammatory response Quality of life |
| 基金项目:福建省自然科学基金面上项目（2020J01964）；福建省卫生健康科技计划项目（2022TG013) |
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| 中文摘要: |
| 摘要 目的：探讨全膝关节置换术（TKA）中不同止血带使用方法的疗效比较及对患者凝血功能、炎症反应和生活质量的影响。方法：选取2019年1月至2022年2月间来我院接受治疗的256例TKA患者，根据止血带使用方法的不同将患者分为A组（n=124，全程使用止血带）和B组（n=132，安装假体至切口缝合包扎完毕间使用止血带）。对比两组临床指标、凝血功能指标、炎症因子指标和生活质量评分。结果：两组术中出血量组间对比差异无统计学意义（P>0.05）。B组的下肢深静脉血栓的发生率低于A组，美国特种外科医院（HSS）评分高于A组，视觉疼痛模拟量表（VAS）评分低于A组（P<0.05）。两组术后1 d 纤维蛋白原含量（FIB）升高，且B组低于A组（P<0.05）。凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血酶时间（APTT）均缩短，且B组大于A组（P<0.05）。两组术后1 d白介素-1β（IL-1β）、白介素-6（IL-6）、白介素-8（IL-8）、C反应蛋白（CRP）均升高，且B组低于A组（P<0.05）。两组术后3个月健康调查量表（SF-36）各维度评分均升高，且B组高于A组（P<0.05）。结论：TKA术中安装假体至切口缝合包扎完毕间使用止血带，可减轻对机体炎症反应、凝血功能的影响，有助于膝关节功能恢复，改善患者术后生活质量。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the efficacy of different tourniquet application methods in total knee replacement (TKA) and its influence on coagulation function, inflammatory response and quality of life of patients. Methods: 256 patients with TKA who were treated in our hospital from January 2019 to February 2022 were selected, and they were divided into group A (n=124, tourniquet was used throughout the whole process) and group B (n=132, tourniquet was used between the installation of prosthesis and the completion of incision suture and dressing) according to the different methods of using tourniquet. The clinical indexes, coagulation function indexes, inflammatory factors indexes and quality of life scores were compared between the two groups. Results: There was no significant difference in intraoperative blood loss between the two groups (P>0.05). The incidence of lower extremity deep vein thrombosis in the group B was lower than that in the group A, the Hospital for Special Surgery (HSS) score was higher than that in the group A, and the visual pain analogue scale (VAS) score was lower than that in the group A (P<0.05). 1 d after operation, the fibrinogen content (FIB) of the two groups was increased, and group B was lower than group A (P<0.05). Prothrombin time (PT), thrombin time (TT) and activated partial thrombin time (APTT) were shortened, and group B was greater than group A (P<0.05). 1 d after operation, interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and C-reactive protein (CRP) were increased in both groups, and group B was lower than group A (P<0.05). The scores of all dimensions of the Short-Form-36 Health Survey (SF-36) were increased in the two groups at 3 months after operation, and group B was higher than group A (P<0.05). Conclusion: The application of tourniquet between the installation of prosthesis and the completion of incision suture and dressing during TKA can reduce the influence on the body's inflammatory reaction and coagulation function, contribute to the recovery of knee joint function, and improve the quality of life of patients after operation. |
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