双侧全髋关节置换术中自体血回输作用探讨

Efficacy of intraoperative blood reinfusion in bilateral total hip arthroplasty?

目的双侧全髋关节置换术病人经常需要输入大量术中及术后异体血,其危险性包括溶血反应、感染乙肝或丙肝、感染HIV或梅毒等。减少异体血输入的最常用方法是采用术中自体血回输。该回顾性研究旨在评价术中自体血回输能否具有减少双侧全髋关节置换术围手术期异体输血总量的作用。方法自2003年1月至2007年6月期间,行双侧首次全髋关节置换术51例,其中26例采用术中自体血回输(A组),25例未用术中自体血回输(B组),回顾性比较两组病人的性别、年龄、体重、身高、疾病、手术医生、手术时间,术前血红蛋白及红细胞压积,术中出血量、自体血回输量、异体血使用量,术后引流量、异体血使用量,术后1、3、7天血红蛋白和红细胞压积。结果A组术中自体血回输330.7±122.7ml(100～557ml)。术中异体血输入量在A组为661.5±437.3ml,B组为888.0±483.3ml(P=0.085)。术后异体血输入量在A组为607.7±672.9ml,B组为328.0±423.8ml(P=0.082)。两组之间术中和术后异体血总输入量无统计学差异(A组1269.2±807.8ml,B组1216.0±706.9ml,P=0.804)。两组之间术后第1天血红蛋白和红细胞压积无统计学差异,而术后第3天血红蛋白和红细胞压积有统计学差异(P=0.020和P= 0.013),术后第7天血红蛋白和红细胞压积又无统计学差异。结论双侧全髋关节置换术术中自体血回输能够减少术中异体输血量,但不能减少围手术期异体输血总量。

Objective Patients undergoing bilateral total hip arthroplastry frequently need large amounts of pefioperative allogenic transfusion, increasing the risk for hemolytic reactions, infecting hepatitis, HIV and syphilis. Intraoperative blood collec- tion and reinfusion are being frequently used to reduce allogenic transfusion. The purpose of this retrospective study was to evalu- ate the effect of intraoperative blood collection and reinfusion in bilateral total hip arthroplastry in reducing perioperative allogenic transfusion. Methods 51 patients were treated by primary bilateral total knee arthroplasty from January 2003 to June 2007, twenty-six patients used intraoperative blood salvage, with using a collectin and reinfusion device （Group A）, twenty-five patients didn＇t use the device （Group B）, we compared sex, age, weight, height, disease, operator, duration of surgery, preoperative hemoglobin and hemotocrit, intraoperative blood loss, intraoperative blood collection and reinfusion, intraoperative allogenic transfusion, postoperative blood loss, postoperative allogenic transfusion, hemoglobin and hemotocrit in 1,3,Tdays after operation. Results Intraoperative blood collection and reinfusion was 330. 7± 122. 7ml （100-557ml） in Group A. Intraoperative allogenic transfusion were 661.5±437.3ml in Group A and 888.0±483.3ml in Group B（P=0. 085）, postoperative allogenic transfusion were 607.7±672.9ml in Group A and 328.0±423.8ml in Group B（P=0. 082）, there were no statistical difference in the total amounts of allogenic transfusion between Groups A （ 1269. 2±807.8 ml） and Group B（ 1216.0 ± 706.9ml） （ P = 0. 804）. Hemoglobin and hemotocrit in the first day after operation didn＇t show any difference between Groups A and B, difference appeared in the third day postoperatively in hemoglobin （P=0, 020） and hemotocrit（P：0. 013）, and again no difference in the seventh day after operation. Conclusions Intraoperative blood collection and reinfusion could reduce the use of intraoperative allogenic transfusion, but couldn＇t reduce the use of perioperative allogenic transfusion in bilateral total hip arthroplasty.