髋关节置换术输血相关因素的回顾性分析

A retrospective analysis of transfusion-associated factors in primary unilateral total hip arthroplasties

目的调查自体血回输在髋关节置换术中的应用效果,探讨影响是否输异体血的相关因素,以及输异体血与术后并发症的关系,为临床合理用血提供依据。方法对2009年1月1日至10月31日在本院应用术中自体血回输进行初次单侧全髋关节置换手术的全部293例患者临床资料进行回顾性分析,根据患者是否输异体血分为输异体血组和未输异体血组,记录患者年龄、性别、体质量、美国麻醉医师协会(ASA)分级、麻醉方式、术前血红蛋白(Hb)浓度、血小板(Plt)计数、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)浓度,术中自体血回输量、异体血输入量、术后引流量、术后是否接受抗凝治疗、术后并发症等指标,并进行统计学分析。结果全部293例患者中,99例患者避免了住院期间输异体血,异体输血免除率为33.7%;年龄、体质量、性别、ASA分级、术前Hb浓度、手术时间、术中出血量以及术后引流量8项参数两组间差异有统计学意义(P<0.05),进一步回归分析后显示,体质量、术前Hb浓度、术中出血量、术后引流量4项参数差异有统计学意义(P<0.01);术后并发症发生率两组间差异有统计学意义(P<0.05)。结论髋关节置换术应用术中自体血回输减小了患者输异体血的风险;体质量、术前Hb、术中出血量和术后引流量是影响是否输异体血的关键因素;输异体血后术后并发症发生率增加。

Objective To demonstrate whether the use of intraoperative blood salvage in primary unilateral total hip arthroplasties reduces the overall rate of allogeneic blood transfusion,to investigate the risk factors leading to allogeneic blood transfusion and to analyse the relationship between postoperative complications and allogeneic blood transfusion.Methods From 2009.1.1 -2009.10.31,total of 293 primary unilateral total hip arthroplasties were performed in Beijing Jishuitan Hospital.The effect of intraoperative blood salvage,the risk factors leading to allogeneic blood transfusion and the postoperative complications were analysed.Results 99 patients of 293（33.7%） didn′t need allogeneic blood transfusion.Logistic regression indicated that：The important predictive factors for allogeneic blood transfusion were preoperative weight level,preoperative hemoglobin concentration,intraoperative blood loss and postoperative blood loss.The incidence of postoperative complications significantly increased when patients accepted allogeneic blood transfusion.Conclusion The use of intraoperative blood salvage significantly lower the allogeneic blood transfusion requirement.Patients may accept allogeneic blood transfusion with lower body weight,lower preoperative Hb level,more blood loss intra-operation and post-operation.Postoperative complications increase when the patient accepts allogeneic blood transfusion.