关节置换术后自体引流血液回输的安全性及有效性

The Security and Effectiveness of Postoperative Autotransfusion After Joint Replacement

目的：探讨关节置换后应用自体引流血回输技术的安全性及有效性。材料与方法：本研究为回顾性研究。本研究选取2010年3月～2010年6月择期初次行人工关节置换术患者共50例．术前无贫血及长期使用抗凝药物史。人工关节为Zimmer或者Stryker公司产品。试验组25人．使用自体血液回输器为北京中科盛康科技有限公司生产的一次性自体血液回收器（型号规格是XH-1000型）或StrykerInstruments（美国）生产的自体血液回收器（型号规格是CBC）．对照组使用负压引流盒。收集两组患者术前、输血前（未输血患者为术后4—6小时）和术后48小时的白细胞、红细胞、血红蛋白、红细胞压积、血小板、血沉、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原、谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、总蛋白、白蛋白、球蛋白、尿素氮、肌酐、尿酸，术后引流血量、异体输血量等。术后两组患者根据术中失血量、术后引流量、红细胞计数、血红蛋白、血压、脉搏、尿量、口唇及眼睑粘膜颜色等情况决定是否输异体血，并对上述数据进行记录分析。结果：试验组患者异体输血为4例．试验组异体输血总量为18IU：对照组为11例．总量为34IU。两组患者术后引流量无统计学差异。分析两组问术后输血前（未输血患者术后4—6小时）和术后48小时的白细胞、红细胞、血红蛋白、红细胞压机、血小板、血沉、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原、谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、总蛋白、白蛋白、球蛋白、尿素氮、肌酐、尿酸，术后引流血量、异体输血量等无统计学差异。结论：目前临床用血与血源紧张的矛盾日益突出的情况下．自体引流血回输作为一种操作简单方便安全的医疗技术．虽然无法完全替代异体输血．但可以保证行人工关节置换术患者术后的基本用血需求。其具有减少异体血输入量、减少异体输血并发症、操作简单方便、降低患者医疗费用等优点．使其在临床上得应用越来越广泛．在关节初次行关节置换术中．应用自体引流血回输技术是安全的．但可以明显减少异体输血量．

Background： Joint replacement is already mature technology, but there are still many complications. For the joint replacement, the drawbacks are the large osteotomy area, the rich the surrounding tissue and so on. This led to a lot of blood loss for the patient with joint replacement. Blood transfusion is the most basic method, for increased circulating blood volume. Allogeneie blood transfusion can cause has more complications, such as： fever, infection, deep venous thrombosis.For reducing transfusion, improving the level of patients＇ erythroeytes and hemoglobin, postoperative autotransfusion is a safe and effective treatment method after total hip and knee replacement. Due to the lack of allogeneic blood, expensive and transfusion complications and other issues, doctors usually choose the preoperative autologous blood, intraoperative drainage autologous blood transfusion and postoperative autotransfusion methods to prevent and correct postoperative anemia. Compared with transfusion,autotransfusion is relatively safe, few complications, such as epidemic,anaphylaxis and so ono This paper mainly discusses the safety and efficacy of postoperative autotransfusion.Objeet： It discussed the security and effectiveness of autologous drainage blood re-transfusion in joint replacement.Materials and method： This study records of 50 patients who were scheduled for the primary joint replacement, by the doctor at Thrid hospital of Ji Lin university between march and june in 2010.Preoperative the patients didn＇t have anamia ,who weren＇t treated with long-term anticoagulant drug. The prosthesis were manufactured by Zimmer （Zimmer Holdings Inc, Warsaw, Indiana） or Stryker （Stryker Corp, Kalamazoo, Michigan）. The test group of 25 is used postoperative auto-transfusion drainage system which corned from Beijing Sheng Kang Limited company or Stryker Instruments. Similarly, the control group including 25 patients, it is the practice of using Negative pressure drainage device. We collected and analyzed the data that is the level of WBC, RBC, Hb ,Het, Pit, ESR, PT, APTT, TT, Fib, ALT, AST, GGT, TP, ALB, GLB, Urea, CRE, UE, postoperative drainage volume, allogeneic blood transfusion volume in preoperative. Before transfusion （post -operative 4-6 hours without transfusion） and in 48 hours after operation, we recorded the data. According to the volume of intra-operative blood loss, postoperative drainage volume, blood pressure, pulse rate, urinary volume, lips and eyelids mucosal color etc,the doctor decided whether the patients are transfused.Results： In the test group, 4 patients were transfused allogeneic blood, a total volume of blood is 18 units. And in the control group, it is 11 patients and 34 units. In two groups of patients, the postoperative drainage volume hasn＇t statistical difference. There were no statistical differences for the level of RBC, Hb, HCT and so on between two groups, that the data was recorded Before transfusion （postoperative 4-6 hours without transfusion） and in 48 hours after operation.Conclusion： This is a contradiction between transfusions which increases ceaselessly and the lack of allogenic blood, it is getting more and more clearly. As a simply medical technology, Antotransfusion can alleviate it. There are lots of advantages, such as reducing allogeneic transfusion and complication of transfusion, reducing the cost of the patients and so on. The emphasis should be reducing the likelihood of transfusion. Although it can＇t replace transfusion, it can be used widely in clinic.