标题：两种负压引流方式对初次人工全髋关节置换术后患者炎症因子水平及失血状况的影响

      作者：王爱明，肖智青，徐洲发，陈焕文，林子华，陈欢    河源市中医院骨伤科二区，广东 河源 517000

      卷次： 2022年33卷4期

      【摘要】 目的 比较两种负压引流方式对初次人工全髋关节置换(THA)患者术后炎症因子水平及失血状况的影响。方法 选择2019年3月至2021年4月河源市中医院收治的70例行THA术的患者为研究对象，按随机数表法将患者分为A组和B组各35例。A组患者采用关节囊内引流，B组患者采用关节囊外引流，比较两组患者术后炎症因子水平及失血状况，包括白细胞介素-1β (IL-1β)、C反应蛋白(CRP)、白细胞介素-6 (IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α (TNF-α)；同时比较两组患者术中出血量、术后第1天和第3天失血量，根据收集数据计算两组患者总失血量和隐性失血量、显性失血量。结果 两组患者术后1 d与术前的各项炎症因子指标比较差异均具有统计学意义(P<0.05)；术前，两组患者的各炎症因子水平比较差异均无统计学意义(P>0.05)；术后1 d，A组患者的CRP、IL-1β、IL-6、IL-10、TNF-α水平明显低于B组，差异均有统计学意义(P<0.05)；两组患者的术中出血量比较差异无统计学意义(P>0.05)，而A组患者的术后引流量、术后第 1天总失血量、术后第 3天总失血量、显性失血量分别为(33.35±8.67) mL、(595.36±157.87) mL、(846.25±210.09) mL、(409.23±116.83) mL，明显多于 B组的(31.56±7.87) mL、(346.12±72.18) mL、(655.67±114.23) mL、(185.81±52.29) mL，隐性失血量为(362.75±65.37) mL，明显少于B组的(502.87±73.35) mL，差异均有统计学意义(P<0.05)。结论 初次全髋关节置换术中采用关节囊外引流相较于关节囊内引流，其CRP等炎性因子指标升高，隐形失血量增加，但术后总失血量明显减少。
      【关键词】 初次人工全髋关节置换；负压引流；总失血量；关节囊外引流；隐形失血量；炎性因子；关节囊内引流
      【中图分类号】 R687.4 【文献标识码】 A 【文章编号】 1003—6350（2022）04—0452—04

Effect of two kinds of negative pressure drainage methods on inflammatory factors and blood loss in patientsafter initial total hip arthroplasty.
WANG Ai-ming, XIAO Zhi-qing, XU Zhou-fa, CHEN Huan-wen, LIN Zi-hua,CHEN HUAN. The Second Department of Orthopedics and Traumatology, Heyuan Hospital of Traditional Chinese Medicine,Heyuan 517000, Guangdong, CHINA
【Abstract】 Objective To compare the effects of two kinds of negative pressure drainage methods on thelevels of inflammatory factors and blood loss in patients after initial total hip arthroplasty (THA). Methods Sev-enty patients with THA admitted to Heyuan Hospital of Traditional Chinese Medicine from March 2019 to April2021 were selected as the research objects. According to the random number table method, they were randomly dividedinto group A and group B, with 35 patients in each group. Patients in group A were treated with negative pressure drain-age inside the joint capsule, and those in group B received negative pressure drainage outside the joint capsul. The lev-els of inflammatory factors and blood loss were compared between the two groups, including interleukin-1β (IL-1β),C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α). At the sametime, the intraoperative blood loss, and the blood loss at the 1st dayand 3rd day after the operation were compared betweenthe two groups. According to the collected data, the total blood loss, hidden blood loss, and dominant blood loss betweenthe two groups were calculated. Results There were significant differences in inflammatory factors between the twogroups 1 day after operation and before operation (P<0.05). Before operation, there was no significant difference in thelevels of inflammatory factors between the two groups of patients (P>0.05). At the 1st day after operation, the levels ofCRP, IL-1β, CRP, IL-6, IL-10, and TNF-α in the group Awere lower than those in group B, and the differences were sta-tistically significant (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). The postoperative drainage, total blood loss on the first postoperative day, total blood loss on the third postoperativeday, and dominant blood loss in group A were (33.35±8.67) mL, (595.36±157.87) mL, (846.25±210.09) mL, (409.23±116.83) mL, which were significantly more than (31.56±7.87) mL, (346.12±72.18) mL, (655.67±114.23) mL, (185.81±52.29) mL in group B; and the hidden blood loss in group A was (362.75±65.37) mL, which was significantly less than(502.87±73.35) mL in group B (P<0.05). Conclusion Compared with drainage inside the joint capsule, CRP and otherinflammatory factors in thedreinage outside the joint capsule increased, and the hidden blood loss increased, but the post-operative total blood loss was significantly reduced.
      【Key words】 Initial total hip replacement; Negative pressure drainage; Total blood loss; Drainage outside thejoint capsule; Hidden blood loss; Inflammatory factors; Drainage inside the joint capsule