人工全膝关节置换术后未洗涤自体引流血形态学研究

Research on erythrocytic morphology in unwashed autologous drainage blood after total knee arthroplasty

目的研究人工全膝关节置换术后未洗涤自体引流血红细胞的形态变化,分析未洗涤自体引流血回输后贫血状态改善不佳的原因。方法2000年11月～2001年3月,20例行人工全膝关节置换术患者,男6例,女14例;年龄32～79岁,平均66岁;骨关节炎17例,类风湿关节炎2例,强直性脊柱炎1例;行单膝置换者6例,双膝同时置换者14例。术前16例预存了自体血400ml,另4例因术前血红蛋白含量较低(<90g/L),且合并其它疾病而未预存自体血。术后均使用CBCⅡConstaVacTM型回输血器进行未洗涤自体引流血回收,并全部回输。分别于术前、术后第2d和第7d进行血常规检查,对术前、术后1h和6h的静脉血与引流血标本进行血常规、血涂片瑞氏染色光镜和扫描电镜观察。结果单膝置换组术中出血量、术后引流血量和引流血回输量分别平均为208.3ml、910ml和708.3ml,术后1例患者因贫血输入800ml库存异体血。双膝置换组术中出血量、术后引流血量和引流血回输量分别平均为296.4ml、1718.2ml和1370ml,术后5例患者因贫血共输入2200ml库存异体血,平均440ml。术后第2d和第7d所有患者的血常规均显示不同程度的贫血,术后引流血中血红蛋白和血细胞比容均较低,并存在较多的变形红细胞。

Objective To study the erythrocytic morphological changes in unwashed autologous drainage blood after total knee arthroplasty (TKA), on account of the postoperative anemia status that was poorly improved after reinfusion. Methods 20 patients (34 knees) underwent TKA from November 2000 to March 2001. There were 6 males and 14 females, whose average age was 66 years (range, 32-79 years). TKA was performed unilaterally in 6 patients, and bilaterally in 14 patients. The disorders were diagnosed as OA in 17, RA in 2 and AS in 1 respectively. All of them received unwashed autologous drainage blood reinfusion, using CBCⅡ Consta VacTM blood salvage system. Blood routine tests were performed preoperatively and on the second and seventh day postoperatively. Blood routine and blood smear tests were also performed on the preoperative blood samples, the postoperative venous blood and drainage blood samples at the first and sixth hour respectively. Erythrocytic morphological changes in these samples were observed under light and electric microscope. Results In the unilateral TKA group, the blood loss in the operation was 208.3 ml, the mean volume of drainage blood was 910 ml,of which 708.3 ml was reinfused; One patient received 800 ml of allogenic bank blood due to postoperative anemia. In the bilateral TKA group, the blood loss, the mean volume of the drainage blood and reinfused volume of blood were 296.4 ml, 1718.2 ml and 1370 ml respectively; Five patients received a total amount of 2200 ml of allogenic bank blood, the average volume was 440 ml. Anemia of different degrees was found at the 2nd and 7th day postoperatively. Compared to venous blood, the levels of hemoglobin and hematocrit were lower in shed blood, and more erythrocytes were deformed. Conclusion The relatively large number of deformed erythrocytes is one of the important reasons that the anemia status is poorly improved postoperatively after reinfusion.