霍蓁 任俊涛 黄涛 张云飞

[摘要]目的探討术后应用去氨加压素对初次单侧全膝关节置换术患者术后出血的影响。方法选取2019年6月至2020年12月于襄阳市中医医院行初次单侧全膝关节置换术的老年患者106例，随机分为 DDAVP 组（ n=52）和对照组（ n=54），对两组患者年龄、身高、体重、术前血红蛋白水平、术后血红蛋白水平、血红蛋白下降值、总出血量、引流量、隐性出血量、血容量、术前红细胞比容（Hct）水平、术后Hct水平、Hct下降值等观察指标进行统计学分析。结果两组患者术后总出血量、术后隐性出血量、术后第1天引流量、术前及术后血红蛋白水平、血红蛋白下降值、血容量、术前及术后Hct水平、Hct下降值比较，差异无统计学意义（P >0.05）;两组患者总引流量、术后第2天引流量比较， DDAVP 组低于对照组，差异有统计学意义（P <0.05）。结论术后应用去氨加压素对全膝关节置换术术后出血无明显影响，但可减少术后总引流量，有助于缩短术后引流管使用时间。

[关键词]去氨加压素;氨甲环酸;全膝关节置换;术后失血

[中图分类号] R687.4  [文献标识码] A   [文章编号]2095-0616（2021）23-0116-04

The effect of desmopressin on bleeding after total knee arthroplasty

HUO  Zhen    REN  Juntao    HUANG  Tao    ZHANG  Yunfei

1. College of Acupuncture and Orthopedics， Hubei University of Chinese Medicine， Hubei， Wuhan 430061， China;2. Department of Lower Limb Orthopedics， Xiangyang Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Chinese Medicine， Hubei， Xiangyang 441000， China

[Abstract] Objective To investigate the effect of postoperative application of desmopressin on postoperative bleeding in the patients who have undergone primary unilateral total knee arthroplasty. Methods A total of 106 elderly patients who underwent the primary unilateral total knee arthroplasty in Xiangyang Hospital of Traditional Chinese Medicine from June 2019 to December 2020 were selected and randomly divided into the DDAVP group （n=52） and the control group （n=54）. The observation indices of the two groups of patients such as age， height， weight， preoperative hemoglobin level， postoperative hemoglobin level， decreased hemoglobin value， total bleeding volume， drainage volume ，concealed bleeding volume，blood volume， preoperative Hct level， postoperative Hct level and decreased Hct value were statistical analysis. Results Total bleeding volume， postoperative concealed bleeding volume， drainage volume on the first day， preoperative and postoperative hemoglobin level ，decreased hemoglobin value， blood volume， preoperative and postoperative Hct level and decreased Hct value were compared between the two groups of patients， the results showed that the differences were statistically insignificant （P >0.05）. When the total drainage volume and the drainage volume on the second day were compared between the two groups of patients， those of the DDAVP group were lower than those of the control group， and the differences were statistically significant （P <0.05）. Conclusion The postoperative application of desmopressin produces no obvious effect on bleeding after total knee arthroplasty， but it can reduce postoperative total drainage volume， and it's expected to shorten the service duration of drainage tube after operation.

[Key words] Desmopressin; Tranexamic acid; Total knee arthroplasty; Postoperative blood loss

围术期失血是影响全膝关节置换术患者术后康复的重要因素，在全膝关节置换术围手术期控制出血环节中，临床常使用氨甲环酸作为主要止血药物，但氨甲环酸可通过血脑屏障引发氨甲环酸相关癫痫[1]，近期研究发现其大量局部应用有毒害关节软组织的风险[2-3]，其用药剂量问题需要注意。醋酸加压素可增加血管性血友病抗原因子（vWF）、凝血因子Ⅷ的释放，增加血小板功能，减少出血时间，从而达到止血目的[4]。本研究在术后第1天静滴去氨加压素注射液，观察其是否对全膝关节置换术后出血情况产生影响，现报道如下。