人工全膝关节置换术后自体引流血回输的临床效果

Clinic outcomes of autologous drainage blood transfusion after total knee replacement

目的探讨人工全膝关节置换术后自体引流血回输的安全性及有效性。方法人工全膝关节置换178例,术后采用Consta VacTM CBCⅡ自体血回输器引流并回输术后<6 h,引流血115例,其中双膝同时置换32例;采用普通引流63例,引流血被弃置,其中双膝同时置换19例。统计2组患者术前、术后d 1、3、5、7 Hb、引流血量、回输血量、异体血输血量,输血反应发生例数及早期并发症情况;输异体血标准为根据患者的Hb水平决定异体血的回输量,使术后Hb水平维持在100 g/L以上。结果 2组间术前、术后d 1、d 5、d 7时的Hb水平没有统计学意义,术后3 d Hb下降明显(P<0.05),需要输异体血。在单膝置换时,自体血回输组引流量平均(610.84±102.35)ml,普通引流组引流量平均(520.89±86.71)ml,回输血量(390.36±86.34)ml,输异体血的比例,未回输组为36.36%,平均输异体血(360.65±103.49)ml,回输组为21.69%,平均输异体血(180.64±96.75)ml(P<0.01)。在双膝置换时,自体血回输组引流量平均(1 270.68±103.68)ml,回输血量(810.94±152.35)ml,普通引流组引流量平均(970.73±98.34)ml,输异体血的比例,未回输组为100%,平均输异体血(810.68±136.58)ml,回输组为90.63%,平均输异体血(580.94±102.45)ml(P<0.01)。自体引流血回输有2例出现轻微寒战,输异体血有3例出现轻微寒战,无皮肤出现黄疸,术后直接胆红素和总胆红素2组无升高,无伤口感染。结论自体引流血回输在全膝关节置换术中应用是安全有效的,能有效减少异体血量的输入。

Objective To evaluate the safe and effect of autologous drainage blood transfusion after TKR. Methods In this clinical trial 178 patients received primary total knee replacement 115 patients （reinfusion group）received filtered shed blood using Consta VacTM CBC Ⅱ autotransfusion system in 6 hours after operation, including 32 bilateral total knee replacement. 63 patients（control group）received a regular drain, including 19 bilateral total knee replacement. Hemoglobin （Hb） level were obtained before and 1st, 3th ,5th and 7th after surgery. Drainage vlolume, the amount of retransfused shed blood,the number of allogeneic blood transfusions and complications were registered. When Hb level dropped below 100 g/ gL,an allogeneic blood transfusion was given. Results There were no significant differences between two groups in Hemo- globin（Hb） level before and 1st ,5th and 7th after surgery. Patients with bilateral total knee replacement was given allogeneic blood transfusion because Hb level dropped below 100 g/L 3 d after surgery（P 〈0. 05）. Patients with unilateral total knee replacement, Drainage vlolume were （610. 84 ±102. 35 ）ml in the reinfusion group and （520. 89±86.71 ） ml in the control group,and the amount of retransfused shed blood were（390. 36±86. 34）ml. 36. 36% patients in the control group received allogeneie blood transfusion, with the number of allogeneic blood transfusions （ 360. 65±103.49 ） ml. 21.69% patients in the reinfusion group received allogeneic blood transfusion, with the number of allogeneic blood transfusions （180. 64±96. 75 ） ml （ P 〈0.01）. Patients with bilateral total knee replacement, drainage vlolume were （ 1 270. 68±103.68） ml in the reinfusion group and （970. 73 ±98. 34）ml in the control group, and the amount of retransfnsed shed blood were （810.94± 152. 35 ）ml. 100% patients in the control group received allogeneic blood transfusion, with the number of allogeneic blood transfusions（810. 68±136. 58）ml. 90. 63% patients in the reinfusion group received allogeneie blood transfusion ,with the number of allogeneic blood transfusions（580. 94 ±102. 45） ml （P 〈0.01）. 2 patients in the reinfusion group appearance shivering and 3 patients in the control group appearance shivering. No other complications were observed. Conculsion Postoperative retransfusion of filtered shed blood is effective for decreasing allogeneie blood transfusions after total knee athroplasty.