全膝关节置换术围手术期异体输血率及其影响因素

Allogeneic Transfusion Rate and Related Factors in Primary Total Knee Arthroplasty

目的：调查全膝关节置换术（total knee arthroplasty， TKA）围手术期异体输血率并分析其相关影响因素。方法回顾性分析北京协和医院骨科2005年1月至2011年12月临床资料完整的初次TKA患者共1165例，其中男217例，女948例；平均年龄62.4岁（16～92岁）。调查患者围手术期异体输血率。对纳入研究的617例单侧TKA病例的自变量（包括34个影响因素）和因变量（住院期间异体输血）进行统计分析，用多因素Logistic回归分析确定住院期间异体输血的影响因素。结果1165例TKA手术患者总异体输血率为58.2％（678/1165），平均异体输血量为2.7 U （1～13 U）。其中695例单侧TKA患者异体输血率为40.0％（278/695）；470例一期双侧TKA患者异体输血率为85.1％（400/470）。共617例单侧TKA病例进入统计分析，单因素分析显示患者年龄（ P＜0.0001）、术前血红蛋白水平（ P＜0.0001）、术前血细胞比容（P＜0.0001）、美国麻醉医师学会（American Society of Anesthesiologists， ASA）评分≥3分（P＝0.004）、手术时间（ P＝0.004）和止血带时间（ P＝0.050）与异体输血呈显著相关；多因素Logistic 回归分析证实异体输血和年龄（P＜0.0001）、术前血红蛋白水平（P＜0.0001）、手术时间（P＜0.0001）之间呈显著相关。结论 TKA围手术期异体输血率较高。一期双膝同期置换更需注意术后贫血事件的发生。通过评估患者年龄、血红蛋白水平及手术时间，有利于预测术后异体输血的需求。

Objective To evaluate the transfusion rates and identify perioperative factors associated with allogeneic blood transfusion （ AllTx） after primary total knee arthroplasty （ TKA） with routine use of low-molecu-lar-weight heparins .Methods We retrospectively studied the transfusion rate of 1165 consecutive patients who underwent primary TKA between January 2005 and December 2011 .Totally 34 independent variables were ana-lyzed in 617 primary unilateral TKAs without autologous blood predonation for requirement of AllTx .Multiple re-gression analysis model was used to identify risk factors associated with perioperative blood transfusion .Results Overall, 58.2% （678/1165 ） of patients required AllTx .The median number of units transfused was 2.7 U （ range：1 to 13 U）.The AllTx rate was 40.0%（278/695） in unilateral TKA procedures and 85.1%（400/470） in one-stage bilateral TKA procedures .Univariate analysis demonstrated the risk of transfusion was independently＆amp;nbsp;predicted by the patients＆#39;age at surgery （ P〈0.0001 ） , preoperative hematocrit （ P〈0.0001 ） , preoperative he-moglobin concentration （P〈0.0001）, American Society of Anesthesiologists （ASA） score ≥3 （P=0.004）, surgical time （ P=0.004 ） , and tourniquet time （ P=0.050 ） .Multivariate Logistic regression analysis confirmed significant relationship between allogeneic blood transfusion and age （ P 〈0.0001 ） , preoperative hemoglobin （ P〈0.0001 ） , and surgical time （ P〈0.0001 ） .Conclusions AllTx rate is high in TKA procedures , especial-ly in one-stage bilateral TKA procedures .Patient＆#39;s age, preoperative hemoglobin level , and surgical time are helpful in identifying high-risk patients who require postoperative blood transfusion .