Yusuf AKSOY, Levent ALTINEL, Kamil Çağrı KÖSE

Ameliyat sırasında kanama kontrolü ve ameliyat sonrası dren kapatılması yöntemlerinin total diz artroplastisi sonrası kan kaybı ve transfüzyon ihtiyacı üzerine etkileri

Amaç: Total diz artroplastisi (TDA) ameliyatı sonrası kanama kontrolü veya kanama kontrolü yapılmadan 2 saatlik dren kapatılması yöntemlerinin, ameliyat sonrası drenaj miktarı ve kan transfüzyonu ihtiyacı üzerine olan etkilerinin incelenmesi amaçlandı. Çalışma planı: TDA yapılan 71 hasta rastgele iki gruba ayrıldı. A grubunda 32 hastanın 44 dizi, B grubunda 39 hastanın 51 dizi çalışmaya alındı. A grubunda kanama kontrolü yapılmadan yara kapatıldı ve dren ilk 2 saat kapalı tutuldu. B grubunda ameliyat sonrası kanama kontrolü yapılıp, yara kapandıktan sonra dren kuruldu. Her iki grupta da 48 saat sonunda drenler çekildi. Aynı seansta tek diz veya çift diz ameliyat edilen hastalar ayrı ayrı değerlendirildi. Gruplar hemoglobin (Hb) değerleri, toplam drenaj miktarları ve toplam kan transfüzyon sayıları açısından karşılaştırıldı. Bulgular: Grupların ameliyat öncesi ve ameliyat sonrası ilk üç gündeki ortalama Hb değerleri benzer bulundu. Dren yoluyla olan kan kaybı, A grubunda tek taraftan ameliyatlı dizlerde 696.1 ±235.4 ml, çift taraflı ameliyatlı dizlerde toplam 1010.8±535.5 ml, B grubunda tek taraftan ameliyatlı dizlerde 710.1±380.1 ml, çift taraftan ameliyatlı dizlerde toplam 878.3±489.6 ml olarak saptandı. Hasta başına yapılan kan transfüzyon ortalaması 1.41 ünite iken, iki grup arasında yapılan kan transfüzyon miktarları açısından fark bulunmadı. Çıkarımlar: TDA sonrası kanama kontrolsüz iki saatlik dren kapatılması yöntemi, basit ve uygulanabilir bir yöntem olmasına karşın, ameliyat sonumda kanama kontrolü yapılmasına kıyasla kan kaybı ve ameliyat sonrası transfüzyon ihtiyacında değişikliğe yol açmamıştır. Bununla birlikte, ameliyat süresini kısaltma açısından uygulanabilir bir yöntem olarak değerlendirilebilir.

Anahtar Kelimeler:

Artroplasti, replasman, diz, Drenaj, Perioperatif dönem, Tedavi sonucu, Ameliyat sonrası kanama, Kansız medikal ve cerrahi girişim, Kan nakli, Hemostaz, cerrahi, Kan kaybı, cerrahi, İzleme, ameliyat sırasında

The comparison of the effects of intraoperative bleeding control and postoperative drain clamping methods on the postoperative blood loss and the need for transfusion following total knee arthroplasty

Objective: We aimed to determine and compare the effects of intraoperative bleeding control and two hours postoperative drain clamping method on postoperative wound drainage and the need for donor blood transfusion following total knee arthroplasty (TKA). Methods: Seventy-one patients who underwent TKA were randomly assigned into two groups. Fourty-four knees of 32 patients comprised Group A and 51 knees of 39 patients comprised Group B. In Group A, no bleeding control was done and postoperatively, the drain was clamped for 2 hours. Then it was unclamped to begin aspiration after the 2nd hour. In Group B, the bleeding was controlled intraoperatively, and the drain was not clamped after the surgery. Drains were removed 48 hours after the surgery in both groups. Bilateral and unilateral arthroplasty patients were eval uated separately. The groups were compared for their preoperative and postoperative 3-day haemoglobin (Hb) levels, total drainage amount and total number of blood transfusions. Results: The haemoglobin levels were similar in both groups preoperatively and at the 1st, 2nd and 3rd postoperative days. In Group A, the wound drainage was 696.1±235.4 ml in unilateral TKA patients and was 1010.8±535.5 ml in bilateral arthroplasty patients. In Group B, the wound drainage was 710.1±380.1 ml in unilateral TKA patients and was 878.3±489.6 ml in bilateral arthroplasty patients. The mean number of transfusions was 1.41 units with no significant differ ences between the groups. Conclusion: The two hour drain clamping method without intraoperative bleeding control does not seem to affect the amount of blood loss and the need for transfusion when compared to intra operative bleeding control in total knee arthroplasty patients. Hovewer, it is a simple and feasi ble method and can be used to decrease the operation time.

Keywords:

Arthroplasty, Replacement, Knee, Drainage, Perioperative Period, Treatment Outcome, Postoperative Hemorrhage, Bloodless Medical and Surgical Procedures, Blood Transfusion, Hemostasis, Surgical, Blood Loss, Surgical, Monitoring, Intraoperative,

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