Agarwala Sanjay, Jhaveri Maulik, Menon Aditya
P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, 400016, Maharashtra, India.
J Clin Orthop Trauma. 2020 Jan-Feb;11(1):133-135. doi: 10.1016/j.jcot.2019.03.013. Epub 2019 Mar 21.
The use of closed-suction drainage systems after total knee arthroplasty (TKA) is common practice in India, but with no consensus on its use. In this retrospective study, we compared whether clamped or unclamped drainage has any advantages over the other in unilateral TKA.
Group-A (n = 351) had an unclamped drain removed at 24 h postoperative, with measurement of total drainage at 24 h between January 2011 and February 2013. Group B (n = 349) had drains kept for a total of 8 h-clamped for the first 4 h and unclamped for a further 4, between March 2013 to September 2016. Drainage volume, as well as the hemodynamic markers-hemoglobin (Hb) drop, transfusion rate were evaluated.
Mean drain output in Group- A was significantly higher than Group- B (215.64 ml versus 28.34 ml). The postoperative Hb was significantly higher in Group-B (11.46 g/dl versus 10.57 g/dl). Mean Hb drop was significantly higher in Group A (2.16 g/dl versus 1.18 g/dl). The transfusion rates were lower in Group-B, though not statistically significant.
The 4- hour clamping method effectively reduces drain output and fall in hemoglobin. For those who continue using closed suction drains, clamping could prove to be an effective way of reducing post-operative blood loss and the need for transfusions.
在印度，全膝关节置换术（TKA）后使用闭式吸引引流系统是一种常见做法，但对于其使用尚无共识。在这项回顾性研究中，我们比较了在单侧全膝关节置换术中，夹闭引流与未夹闭引流相比是否具有任何优势。
A组（n = 351）在术后24小时拔除未夹闭的引流管，并于2011年1月至2013年2月期间测量24小时的总引流量。B组（n = 349）在2013年3月至2016年9月期间，引流管总共保留8小时，前4小时夹闭，后4小时不夹闭。评估引流量以及血流动力学指标——血红蛋白（Hb）下降情况、输血率。
A组的平均引流量显著高于B组（215.64毫升对28.34毫升）。B组术后血红蛋白水平显著更高（11.46克/分升对10.57克/分升）。A组的平均血红蛋白下降幅度显著更大（2.16克/分升对1.18克/分升）。B组的输血率较低，尽管无统计学意义。
4小时夹闭法可有效减少引流量和血红蛋白下降。对于继续使用闭式吸引引流管的患者，夹闭可能是减少术后失血和输血需求的有效方法。
