CAJ | 학술논문

目的评价去氨加压素减少全髋关节置换术(THA)患者围手术期出血量的效果.方法 2007年9月至2009年6月,选取62例拟行单侧THA的患者,男28例,女34例.采用随机数字表法分为治疗组和对照组,每组31例:治疗组用去氨加压素按照0.3 μg/kg体质量溶于100 mL生理盐水配制,静脉滴注,术前30 min应用1次,术后1次/d,连续用2 d;对照组仅给予等剂量生理盐水静脉滴注.比较两组患者失血总量、术中失血量、术后可见失血量、输血量、术前及术后血红蛋白(Hb)、红细胞比容(Hct)、血小板(Plt)、纤维蛋白原(Fib)、凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)等指标,并以彩色多普勒超声观察患者术后下肢深静脉血栓形成的发生情况.结果两组患者的总输血比例、实际失血总量、输血量比较差异均有统计学意义(P＜0.05);而术后输血比例、手术时间、术中失血量、术后24 h可见失血量、全部可见失血量差异无统计学意义(P＞0.05).两组患者术后Hb、Hct、Plt及APTT比较差异均有统计学意义(P＜0.05),而Fib、PT比较差异无统计学意义(P＞0.05).术后14 d两组均未发现下肢深静脉血栓形成.45例患者获1～3个月随访,仅2例表现为下肢静脉功能不全.结论在THA术中及术后短期使用去氨加压素能有效减少患者的失血量和输血量.
목적 평개거안가압소감소전관관절치환술(THA)환자위수술기출혈량적효과.방법 2007년9월지2009년6월,선취62례의행단측THA적환자,남28례,녀34례.채용수궤수자표법분위치료조화대조조,매조31례:치료조용거안가압소안조0.3 μg/kg체질량용우100 mL생리염수배제,정맥적주,술전30 min응용1차,술후1차/d,련속용2 d;대조조부급여등제량생리염수정맥적주.비교량조환자실혈총량、술중실혈량、술후가견실혈량、수혈량、술전급술후혈홍단백(Hb)、홍세포비용(Hct)、혈소판(Plt)、섬유단백원(Fib)、응혈매원시간(PT)급활화부분응혈활매시간(APTT)등지표,병이채색다보륵초성관찰환자술후하지심정맥혈전형성적발생정황.결과 량조환자적총수혈비례、실제실혈총량、수혈량비교차이균유통계학의의(P＜0.05);이술후수혈비례、수술시간、술중실혈량、술후24 h가견실혈량、전부가견실혈량차이무통계학의의(P＞0.05).량조환자술후Hb、Hct、Plt급APTT비교차이균유통계학의의(P＜0.05),이Fib、PT비교차이무통계학의의(P＞0.05).술후14 d량조균미발현하지심정맥혈전형성.45례환자획1～3개월수방,부2례표현위하지정맥공능불전.결론 재THA술중급술후단기사용거안가압소능유효감소환자적실혈량화수혈량.
Objective To evaluate the clinical value of desmopressin in reducing blood loss following total hip arthroplasty (THA) .Methods From September 2007 to June 2009, 62 patients (28 males and 34 females) underwent THA.They were randomly divided into 2 even groups.Group A (desmopressin group) received intravenous administration of desmopressin(0.3 μg/kg diluted in 100 mL normal saline) at 30 minutes preoperatively and in 2 consecutive days postoperatively.Instead Group B (control group) received intravenous administration of normal saline of the same volume and in the same manner.The amounts of calculated total blood loss, intraoperative blood loss, postoperative wound blood loss and blood transfusion were recorded.The hemoglobin concentration (Hb) , hematocrit (Hot), platelet (Plt),fibrinogen (Fib), prothrombin time (PT), activated partial thromboplastin time (APTT) were also examined one day before and one day after operation for comparison.The patients were examined for occurrence of deep vein thrombosis(DVT) by Color Doppler Flow Imaging.Results The intraoperative blood loss was 375 ±43 mL in Group A and 392 ± 55 mL in Group B, without significant difference between the 2 groups ( P ＞0.05 ).The postoperative drainage volume was 276 ± 49 mL in Group A and 294 ± 52 mL in Group B with no significant difference either ( P ＞ 0.05).The total blood loss was 920 ±80 mL in Group A and 1150 ±99 mL in Group B, with a significant difference between the 2 groups ( P ＜ 0.05) .There were also significant differences between the 2 groups in average amount of blood transfusion, patients needing blood transfusion and postoperative Hb, Hct, Plt levels and APTT( P ＜ 0.05).No DVP event was found 14 days postoperation in either group.Conclusion During and following THA, a short-term use of desmopressin can significantly decrease blood loss and transfusion required.