自体与异体输血在人工髋关节置换术中的应用比较

Comparison between allogenic and autologous blood transfusion for in hip arthroplasty

目的:比较人工髋关节置换术中自体与异体输血的经验,以及预存自体血和术中自体血回输患者血常规和生化指标的变化。方法:回顾分析188例人工髋关节置换术中的输血情况,其中,预存自体血回输组(A组)62例,术中自体血回输组(B组)76例,未作自体输血的人工髋关节置换术组(C组)50例。结果:A组、B组术后分别有64.5%(40/62)和61.8%(47/76)无需输异体血而顺利渡过围手术期,明显多于C组(P<0.05),A组、B组异体血用量也明显少于C组(P<0.05)。A组采血前、后血液指标无显著差异,B组术后1天患者RBC、H b、H CT均明显低于手术前(P<0.05),但无失血反应,术后1周恢复正常。电解质术前、术后无异常。术中回输血经光镜观察回收处理后红细胞形态正常、无碎片。回收血培养均呈阴性。结论:自体输血是一种安全、经济、副反应较少的高质量输血,能使绝大多数施行人工髋关节置换术的病例避免输异体血,方法简便、可靠,值得推广使用。

Objective： To compare the experience obtained in allogenic and autologous blood transfusion used in hip arthroplasty. Methods： 188 cases of hip arthroplasty were retrospectively analyzed, and the patients were divided into three groups. Group A （62 patients）received preoperative storage and transfusion of autolognus blood during the operation. Group B（76 patients） received reinfusion of shed blood during the operation. Group C （50 patients）only received allogenic blood transfusion. Results： In group A and B, 64.5%（40/62） and 61.8% （47/76）of the patients,respectively passed perioperative period successfully without allogenic blood transfusion.However the proportion in group C was 32% （ 16/50 ）. The quantity of allogenic blood transfusion used in Group C was significantly higher than that in Group A and B （ P〈0.05 ）. Before or after autologous blood storage, there were no significant differences in hemoglohins and hematocrits in Group A. In Group B, the blood constituent almost reached normal one week after operation. Conclusions： Autologous blood transfusion used in hip arthroplasty is very safe, economic, with less side reactions and high quality blood transfusion.Reinfusion of autologous shed blood can be advised to use for its safety ,convinence and effectiveness in the majority of arthroplasty cases.