人工全膝关节置换术隐性失血的发生机制及影响因素分析

Mechanism and affecting factors of hidden blood loss in total knee arthroplasty

[目的]探讨人工全膝关节置换术(total knee arthroplasty,TKA)隐性失血的发生机制及其危险因素作用关系。[方法]对本院2008年1月～2010年3月病例中抽取80例单侧TKA,通过Gross方程计算出隐性失血量。记录不同年龄(以70周岁为界),有无内科疾病(高血压病、糖尿病、冠心病),性别,止血带时间,不同疾病之间,肥胖(BMI 30 kg/m2为界)等情况下围手术期隐性失血量,分析讨论围手术期隐性失血的发生机制和危险因素。[结果]TKA围手术期失血总量平均为1 608 ml,隐性失血为828 ml,占51.5%。年龄、有无内科疾病、性别、止血带时间在隐性失血的量方面差异有统计学意义,而不同疾病之间、肥胖则在隐性失血的量方面差异无统计学意义。[结论]高龄患者、有内科疾病症者、男性、止血带时间较长者等情况下隐性失血增多,对这些情况围手术期更应提高认识,自体血回输尚不能完全满足机体需要,及时补充异体血。

[ Objective] To explore the mechanism of hidden blood loss and risk factors of interaction in TKA. [ Methods] We studied 80 cases of unilateral TKA in our hospital from January 2008 to March 2010. The amount of hidde blood loss was cal- culated by the Gross equation. We studied perioperative hidden blood loss difference of TKA in different ages （70 years for the sector）, with or without medical illness （hypertension, diabetes, Coronary heart disease）, gender, tourniquet time, between different diseases and obesity （ body mass index BMI 30 kg/m2 for the sector） or not. And we explored the mechanism of hidden blood loss and risk factors of interaction. [ Results] In TKA group, the mean actual perioperative blood loss was 1608 ml, hid- den blood loss was 828 ml, accounted for 51.5%. The hidden blood loss showed statistically significant difference in age, with or without medical illness, gender and tourniquet time in TKA, while the difference was not statistically significant in different diseases and obesity or not. [ Conclusion ] The hidden blood loss increase in elderly patients, patients with medical illness, male and with longer tourniquet time. Autologous blood transfusion dosen＇ t fully meet the needs of the body and allogeneic blood is replenished.