关节置换术围术期血液丢失影响因素的探讨

The influence associated with an increased blood loss in patients undergoing joint replacement

目的:探讨髋关节置换术(total hip replacement,THR)与膝关节置换术(total knee replacement,TKR)围术期血液丢失的可能因素。方法:选择2010年4月至6月入院ASAⅠ～Ⅲ级,行择期、单侧THR与TKR的患者119例,记录术中失血量、液体(人工胶体及红细胞悬液)输注量、手术时间、术后引流量。收集患者术前血红蛋白(Hb)和红细胞容积(Hct)值,及术后1、2和3 d测得Hb与Hct值取最低值。采用Spearman等级相关分析法、二项分类Logistic回归分析的向前引入法,比较患者手术前后Hb、Hct的变化,分析影响术中出血量与术后引流量的相关因素。结果:术前Hb、Hct与相应术后Hb、Hct呈显著正相关;年龄、手术时间是影响术中出血量的独立预测因素,手术种类、术中胶体输注量是影响术后引流量的独立预测因素(P<0.05)。结论:(1)术前维持较高的血红蛋白水平,对术中出血量并无明显影响,但可降低术后贫血发生率。(2)术中出血量的多少与患者年龄及手术时间密切相关。(3)THR与TKR患者术后引流量存在明显差异。(4)术中大量胶体的输注可能增加术后血液丢失。

Objective： To investigate the influence of an increased blood losing in patients undergoing joint replacement.Methods： One hundred and nineteen patients（ASA Ⅰ~Ⅲ,28~86 years old,forty five male and seventy four female） undergoing elective unilateral joint replacement were recruited in the study.The blood-loss,liquid（colloidal solution and blood-transfusion）,surgical hours and the amount of drainage were recorded.The pre-operative data of haemoglobin,hematocrit,as well as the lowest level of the post-operative data were documented.The influence of blood-loss and drainage were compared and analyzed in patients undergoing joint replacement.Results： The pre-operative haemoglobin and hematocrit were positively related with the post-operative data.Age and surgical hours were the independent predictive factors of blood-loss.The opreation itself and the amount of colloidal use are the independent predictive factors of drainage.Conclusion：（1） Maintaining the level of pre-operative haemoglobin places no obvious effect on blood-loss during operation,which,however,reduces the rate of post-operative anemia.（2） The intra-operative blood-loss is closely connected with patients＇ age or surgical hours.（3） There is an evident difference in drainage between replacement of hip joint and knee joint.（4） An excess of colloidal transfusion can raise the amount of drainage.