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止血带使用时间与全膝关节置换术肺脂肪栓塞风险的实验研究 被引量：1

The experimental study on risk between tourniquet and fat pulmonary embolism following total knee arthroplasty
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摘要 [目的]探讨全膝关节置换术中止血带的使用与肺脂肪栓塞产生的相关性。[方法]32只健康犬随机分为四组,A组:模拟全膝关节置换术,截骨、扩髓,插入髓内杆,术中使用止血带60 min;B组:操作同A组,术中使用止血带90 min;C组:术中操作同A组,术中不使用止血带;D组:术中仅使用止血带60 min,不模拟全膝关节置换。术中监测不同时间动脉血气分析和凝血指标,术后进行肺脏病理检查并采用病理学评分计算肺损伤程度。统计分析采用卡方检验和非参数检验。[结果]不考虑时间因素时,止血带90 min组与其余组比较,PaO2差异显著(F=3.013,P=0.047),考虑时间因素时,止血带90 min组在术毕和术后5 min时,Pa O2差异亦显著(F=3.427,P=0.029)。PaCO2各组间在术中术后无统计学差异。凝血指标中两组各时间点PT、APTT无显著差异(F=0.616,P=0.61)。肺组织病理切片显示:肺损伤总分止血带90 min组高于其余各组(x2=19.996,P=0.001)。[结论]全膝关节置换术后止血带释放时可能干扰呼吸系统功能,增加肺脏脂肪栓塞的发生风险,尤其在止血带使用时间达到90 min时。 [Objective] To investigate whether a tourniquet could increase the risk of fat pulmonary embolisms in total knee arthroplasty（TKA）.[Method]Thirty-two dogs were randomized into 4 groups：group A was underwent simulated TKA with a tourniquet in 60 minutes（n=8）,group B was underwent simulated TKA with a tourniquet in 90 minutes（n=8）,group C without a tourniquet（n=8） and group D was treated as controlled group with a tourniquet in 60 minutes（n=8）.Arterial blood gas analysis（PaO2 and PaCO2） and index of blood coagulation（prothrombin time,PT,and actived partial thromboplastin time,APTT） were tested at different time during the operation.HE-staining for lung was used to detect the degrees of pulmonary injury.[Result]PaO2 significantly decreased after the tourniquet was released in group B compared with the non-tourniquet group without considering the time factor（F=3.013,P=0.047）.PaO2 significantly decreased at 0 and 5 minutes after the tourniquet was released in group B compared to the non-tourniquet group（F=3.427,P=0.029）.There was no significant difference in PT and APTT in the four groups（F=0.616,P=0.61）.Pulmonary injury score was higher in group B than in the other groups（x2=19.996,P=0.001）.[Conclusion]The use of a tourniquet in TKA may damage blood vessel endothelium,tourniquet release may interfere respiratory system,and increase the risk of fat pulmonary embolism,especially when the tourniquet was used 90 minutes or more.
作者 刘宏滨 张阳 钱齐荣 刘宁 郑玮杰
机构地区 解放军 北京军区总医院全军创伤骨科研究所 上海长征医院骨科
出处 《中国矫形外科杂志》 CAS CSCD 北大核心 2011年第20期1734-1737,共4页 Orthopedic Journal of China
基金 南京军区122工程基金项目
关键词 关节成形术 膝 置换 止血带 肺脂肪栓塞 arthroplasty knee replacement tourniquet fat pulmonary embolism
分类号 R687.4 [医药卫生—骨科学]
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参考文献11

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二级参考文献35

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共引文献34

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中国矫形外科杂志
2011年 第20期

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