利伐沙班抗凝状态下术后自体引流血回输对初次全髋关节置换术后隐性失血和肢体肿胀的影响

Effect of autologous drained blood reinfusion on hidden blood loss and limb swelling following rivaroxaban anticoagulation for primary total hip arthroplasty

目的：研究利伐沙班抗凝状态下自体引流血回输对初次全髋关节置换（total hip arthroplasty, THA）术后隐性失血和肢体肿胀的影响。方法采用病例对照研究，2011年5月-2012年10月98例单侧初次人工全髋关节置换术患者，术后自体引流血回输45例、未采用术后自体引流血回输组53例。自体引流血回输组男20例，女25例；对照组男23例，女30例。两组患者治疗前一般资料差异无统计学意义，具有可比性。比较两组患者术后隐性失血量和大腿中部周径变化最大值。结果术后自体血回输组围术期总失血量1591.1＆#177;337.3 ml，隐性失血量508＆#177;115.1 ml；大腿周径增加值为5.1＆#177;1.6 cm；对照组围术期总失血量1374.5＆#177;317.3 ml，隐性失血量467＆#177;96.8 ml；膝关节周径增加值为3.9＆#177;1.4 cm。两组隐性失血量差异无统计学意义（P＆gt;0.05），膝关节周径增加值差异有统计学意义（P＆lt;0.05）。结论利伐沙班抗凝状态下初次全髋关节置换术后应用自体引流血回输不增加隐性失血量，但会增加肢体肿胀程度。

Objective To study the effect of autologous drained blood reinfusion on hidden blood loss and limb swelling following rivaroxaban anticoagulation for primary total hip arthroplasty. Methods From May, 2011 to October, 2012, 98 patients undergoing primary unilateral total hip arthroplasty received rivaroxaban therapy for prevention of deep venous thrombosis （DVT）. Forty-five of the patients used a drained blood reinfusion device （group A） and 53 patients did not （group B）. Hidden blood loss and the maximal changes of postoperative circumferential length of the mid-thigh were measured and compared between the two groups. Results The mean total blood loss, the hidden blood loss, and the maximal changes of postoperative thigh circumference were 1591.1＆#177;337.3 ml, 1591.1＆#177;337.3 ml, and 5.1＆#177;2.8 cm in group A, as compared to 1374.5＆#177; 317.3 ml, 467 ＆#177; 96.8 ml, 3.9 ＆#177; 1.4 cm in group B, respectively. The two groups showed a significant difference in the maximal changes of postoperative mid-thigh circumference （P＆lt;0.01） but not in hidden blood loss （P＆gt;0.05）. Conclusion Reinfusion of autologous drained blood does not affect hidden blood loss but can increase limb swelling following primary total hip arthroplasty with rivaroxaban anticoagulation.