| 李清山,王志强,孙官军,等.髋关节置换术后放置引流减少非感染性发热时间[J].安徽医药,2019,23(12):2458-2462. |
| 髋关节置换术后放置引流减少非感染性发热时间 |
| Indwelling drainage after total hip replacement reduced the postoperative non?infected fever |
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| DOI：10.3969/j.issn.1009?6469.2019.12.032 |
| 中文关键词: 关节成形术，置换，髋 引流术 血肿 发热 炎症 |
| 英文关键词: Arthroplasty,replacement,hip Drainage Hematoma Fever Inflammation |
| 基金项目: |
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| 中文摘要: |
| 目的研究全髋关节置换术(THA)后留置引流与否同术后非感染性发热时间之间的关系。方法取 2016年 1—12月重庆医科大学附属遂宁市中心医院行 THA病人 75例，失访 15例，使用随机数字表法分为未放置引流管组(A组)、持续引流管组(B组)及间断引流组(C组)每组 20例。观察术前及术后一周体温变化情况，记录术后血红蛋白下降及输血量，记录术后 3、6、 12月髋关节功能 Harris评分。，酶联免疫吸附检测术前及术后 1d、2d、3d及 7d白细胞介素(IL)?6、IL?8、肿瘤坏死因子 α(TNF? α)的含量。结果(1)A、B及 C组分别于术后第 5、3及 4d达到最高峰，分别为(38.6±0.4)℃、(37.5±0.2)℃及(37.8±0.6)℃，体温变化趋势均为先增高后下降。(2)Harris评分 A、B及 C组之间术前［(42.3±8.4)分，(42.4±13.5)分及(42.5±9.2)分］及术后 3月［(73.5±4.3)分，(72.6±4.9)分及(74.3±5.7)分］、 6月［(82.4±3.6)分，(82.5±3.7)分及(83.4±4.1)分］及 12月［(93.7±4.8)分，(92.5±4.3)分及(91.8±5.1)分］差异无统计学意义(P＞0.05)。(3)术后第 1天血红蛋白下降最多，输血量 A组(286.7±123.5) mL与 C组(294.6±120.7)mL，差异，无统计学意义(P＞0.05)。(4)IL?6、IL?8及 TNF?α与术前相比，呈先增加后降低趋势，但术后第 7天仍维持较高水平(P＜0.05)。与 A组最高峰值［ IL?6(527±13)ng/L、IL?8(39.7±4.3)ng/L及 TNF?α(23.54±1.57)ng/L］相比， B组［ IL?6(406±22)ng/L、IL?8(37.7±5.2)ng/L及 TNF?α(17.24±1.23)ng/L］及 C组［ IL?6(421±23)ng/L、IL?8(34.8±4.8)ng/L及 TNF?α(19.57±1.54)ng/L］最高峰值较小(P＜0.05)，B与 C组相比差异无统计学意义(P＞0.05)。结论 THA术后引流管早期夹闭不增加失血量及输血量，减少术后血肿吸收及炎症反应从而减少非感染性发热的持续时间，有利于术后发热鉴别，有效避免术后抗生素的滥用。 |
| 英文摘要: |
| Objective To explore the relationship between indwelling drainage after total hip replacement and the postoperative non ?infection fever.Methods Selected 75 cases from January 2016 to December 2016 in Suining City Center Hospital Affiliated toChongqing Medical University to treat with artificial total hip replacement，and 15 cases were lost to follow?up，which used method of random number table randomly assigned into not indwelling drainage group(group A)and continue indwelling drainage group(group B)and intermittent indwelling drainage group(group C)，20 cases pergroup.Observed temperature to change at a postopera? tive week and preoperative，and hemoglobin reduce，the amount of blood transfusion.We recorded Harris hip score every time at postoperative the third，sixth and twelfth months.Enzyme?linked immunosorbent experimental detected quantity of interleukin 6(IL? 6)and interleukin 8(IL ? 8)，tumor necrosis factor alpha(TNF?α)at the first，second，third，seventh day of postoperaton and pre? operation.Results 1.The group A，B and C reached the highest temperature at postoperative 5(38.6±0.4)℃，3(37.5±0.2)℃，and 4(37.8±0.6)℃days，which temperature changed trend were form increasing to decline.2.Group A，B and C of pre?operation Harris scores are(42.3±8.4)points，(42.4±13.5)points and(42.5±9.2)points.Group A，B and C of 3 months after operation Harris scores are(73.5±4.3)points，(72.6±4.9)points and(74.3±5.7)points.Group A，B and C of 6 months after operation Harris scores are(82.4 ±3.6)points，(82.5±3.7)points and(83.4±4.1)points.Group A，B and C of 12 months after operation Harris scores are(93.7±4.8) points，(92.5±4.3)points and(91.8±5.1)points.Harris scores were no statistically significant difference between group A，B and C(P＞0.05).3.Group A，B and C all had the most at the first postoperative day，and the minimum amount of hemoglobin reduce was group A，but the most was group B.the amount of blood transfusion was no significant difference in group A(286.7±123.5)mL and group C(294.6±120.7)mL(P＞0.05).But compared with group A，in group B blood transfusion volume and decrease hemoglobin value was significant difference(P＜0.05).4.Compared with preoperation，the amount of IL?6，IL?8 and TNF?α in three groups had the tend from increase to reduce.But they still had a higher level at the seventh day(P＜0.05).The peak of group A［IL?6(527± 13)ng/L、IL?8(39.7±4.3)ng/L and TNF?α(23.54±1.57)ng/L］was the third day postoperation，but group B［IL?6(406±22) ng/L、IL?8(37.7±5.2)ng/L and TNF?α(17.24±1.23)ng/L］and C［IL?6(421±23)ng/L、IL?8(34.8±4.8)ng/L and TNF?α(19.57±1.54)ng/L］were the second day.Compared with the highest peak of group A，group B and C peak significantly smaller(P＜ 0.05)，but there was no significant difference at group B and C(P＞0.05).Conclusion Indwelling drainage after total hip replace?ment was clipped early stage which did not increase the amount of blood loss and blood transfusion，and no effect on hip joint func? tion.At the same time，it reduced the postoperative hematoma absorption and the inflammatory response，so it reduced the time of non?infectious fever.So，it was useful to help to identificate postoperative fever，and it can prevent antibiotics to be abused. |
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