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相關文獻
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頁籤選單縮合
題名 | Cardiovascular Changes during Cemented Hip Arthroplasty=施行以骨泥固定人工髖關節置換術中心臟血管系統的變化情形 |
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作者 | 姚振國; 陳天雄; 羅惠熙; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 26:4 民82.07-08 |
頁次 | 頁1847-1854 |
分類號 | 416.61 |
關鍵詞 | 骨泥; 人工髖關節置換術; 心臟血管系統; Cemented hip arthroplasty; |
語文 | 英文(English) |
中文摘要 | 台北榮民總醫院骨科部,從民國72年7月起,至民國80年7月止,總共收集625位病人(723例手術)接受以骨泥固定人工髖關節置換術,其中224位病人(227例手術)接受半髖人工關節置換術,的1位病人(496例手術)接受全髖人工關節置換術。Bipolar group平均年齡為74.4歲,其中男性佔170例,女性54例,THR group平均年齡為58.6歲,其中男性佔295例,女性佔106例。 我們發現,在Bipolar group有97/227(42.7%)的病人,在手術當中發生明顯的血壓下降的現象,而在THR group大多沒有此現象,僅14/496(2.8%)在髖臼端以及65/496(13.1%)在股骨端有明顯的血壓下降情形。而在THR group中有77例為revision case,其中只有2例病患有明顯的血壓下降情形,相對於primary case有16%的病患有此情形。 大多數的血壓變化情形,發生於骨泥及人工關節植入後,數分鐘內發生,而且很快便會恢復,沒有嚴重後遺症產生。但有9例病患不幸發生心臟停止跳動,其中5例不治死亡,3例急救後成為植物人,只有1例恢復良好。另外有4例,手術中發生血壓下降得很低,但及時投予藥物後,3例恢復良好,1例不幸發生急性腎衰竭,但是以後追踪檢查,結果亦為良好。 探討其病因,目前以栓塞理論最為大家所接受,但確實機轉仍然不明,而高危險因素包括老年人,骨質疏鬆,移位性股骨頸骨折病患以及合併有心、肺疾病與轉移性骨癌患者。因此我們在施行以骨泥固定人工髖關節置換術時,必須特別注意病人的病況是否穩定以及手術中的一些預防措施包括股骨骨髓腔內的大量沖洗,減輕腔內壓力等等,特別小心高危險群患者,以減少或避免嚴重併發症的發生。 |
英文摘要 | Over the past eight years, 625 (723 hips) patients who had undergone cemented hip arthroplasty needed because of hip diseases including fractures, osteoarthritis and avascular necrosis were analyzed concerning cardiovascular changes during the surgical procedure. Suppression of the cardiovascular system is common during cement insertion, but most such effects are transient in nature; patients usually recover from them rapidly. Of the group of bipolar endoprosthesis, 42.7% had significant blood pressure drop during operation, far exceeding the total hip replacement (THR) group. 2.6% of the revisional THR patients had such a significant blood pressure drop during operation. However, 16% of the primary cases had significant blood pressure drop respectively. Emboli theory is the most accepted hypothesis, and increased intramedullary pressure may play an important role. There were nine cases of cardiac arrest during operation, of whom five cases expired; three cases became vegetative, and one case survived without sequelae after CPR. Of the four cases which developed profound hypotension during operation, three had blood pressure return to normal after vasopressor drugs, except for one who developed acute renal failure postoperatively. High risk factors included old age, osteoporosis, associated cardiac or pulmonary problems and malignant diseases. Some prophylactic measures have been suggested to prevent or compensate for the cardiorespiratory dysfunction during cemented hip arthroplasty. These measures included inspiring 100% oxygen before insertion of the prosthesis, continuous monitoring for oxygen saturation or PaO2, hemodynamic monitoring and maintaining intravascular volume; voiding pressurization of the intramedullary canal by use of a decompression vent, either a catheter or a hole; meticulous lavage of the intramedullary canal to eliminate the reamed contents can prevent the emboli. |
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