自体血回输在全膝关节置换术中的应用

Application of autologous transfusion salvage in total knee arthroplasty

目的:探讨自体血回输在全膝关节置换手术中的应用及其对围手术期血液指标的影响。方法:将63例全膝关节置换手术患者,按手术种类分为单膝和双膝置换2组,采用美国Medtronic autoLog血液回收系统进行洗涤式自体血回输,分别测定术前、术后第1天、术后第7天血液中RBC、Hb、HCT、PLT、PT、APTT、TT、FIB,比较2组回输量的变化及其对血常规和凝血功能的影响。结果:回输自体血量43 134ml,占总输血量的52.6%。术后RBC、Hb、HCT、PLT、FIB均不同程度减少,PT显著延长(P<0.05),APTT、TT无明显变化。单膝置换组术前与术后第1天的PLT、PT差异有统计学意义(P<0.05),术后第7天恢复正常;双膝置换组术前与术后第1天的RBC、Hb、HCT、PLT、PT、FIB比较差异有统计学意义(P<0.05),术后第7天的PLT差异有统计学意义(P<0.05),其他指标术后第7天恢复正常。结论:自体血回输在全膝关节置换手术中的应用能有效减少异体血量的输入,避免并发症的发生。

Objective：To investigate the application of autologous transfusion salvage in total knee arthroplasty and effects on some blood parameters during the perioperative period. Method： Sixty three patients with total knee arthroplasty were divided into two groups according to operative types,autologous blood transfusion using Ameri- can Medtronie AutoLog blood recovery system, and their blood RBC, Hb, HCT, PLT, PT, APTT, TT and FIB were measured preoperative,exactly 1 day and 7 days postoperative. Blood volume of autologous transfusion sal- vage in two groups was calculated and its effects on the blood routine and coagulation/unction were compared with each other. Result：Blood volume of autologous transfusion salvage was 43 134 ml, and this was 52. 26% in total blood transfusion during the operative periods. The RBC, Hb, HCT,PLT and FIB were decreased in different sta- ges after operation. PT was delayed significantly（P〈0.05）. There was no changes in APTT and TT. In unilateral knee arthroplasty group, preoperative and postoperative day 1 the number of PLT and PT were significantly differ- ent （P〈0.05）, the first seven days after the resumption of near normal;in bilateral knee arthroplasty group, pre- operative and postoperative day 1 the number of RBC, Hb, HCT, PLT, PT and FIB were significantly different （P 〈0.05） ,after the first seven days the number of PLT was significantly different （P〈0. 05） ,other indicators re- turned to normal. Conclusion： Autologous transfusion salvage in total knee arthroplasty surgery could be effective in reducing allogeneie blood input and avoiding complications.