老年骨科患者不同红细胞输注方式的效果评价

The effectiveness evaluation of different red blood cell infusion in elderly patients

目的 建立红细胞输注有效性的评分标准,探讨老年骨科患者围术期输血的有效性。方法 择期行骨科手术患者108例,美国麻醉医师协会评分标准（ASA）Ⅱ-Ⅲ级,性别不限,年龄6080岁,随机分为2组,I组（n=54）使用传统红细胞输注方式,Ⅱ组（n=54）使用以血红蛋白（Hb）和红细胞压积（Hct）为目标导向的红细胞输注方式,比较输注红细胞悬液前后Hb、Hct、红细胞计数（RBC）、血小板（PLT）、凝血酶原时间（PT）、活化部分凝血酶时间（APTT）、肺泡-动脉氧分压差[P（A-a）O2]、氧合指数（OI）和vigileo监测指标的变化,以及切口愈合时间、住院天数和ICU转入率的变化,评价老年骨科患者红细胞输注方式的有效性和安全性。结果 两组患者的有效率分别为59.3%和72.2%,两者之间差异无统计学意义（P〈0.05）。与传统红细胞输注方式组比较,以Hb和Hct为目标导向的红细胞输注方式组患者RBC、Hb和Hct升高,PT和APTT降低,切口愈合时间缩短,ICU转入率降低（P〈0.05）。结论 以Hb和Hct为目标导向的红细胞输注方式,能更有效地提高老年骨科患者围术期红细胞输注的有效性。

Objective Through the establishment of blood transfusion-effectiveness of assessment criteria, to evaluate and analysis the effectiveness of perioperative red blood cell infusion for orthopedics in elderly patients. Methods 108 USA society of Anesthesiologists score standard （ASA）Ⅱ-Ⅲ patients of both sexes aged 60-80 yr scheduled for elective orthopedic surgery were randomly divided into 2 groups： Group I （ n = 54） , use traditional method of red blood cell infusion ; group Ⅱ （ n = 54） , use goal-oriented by hemoglobin （Hb） and hematocrit （Her） of red blood cell infusion, comparison the changes of the Hb, Hct, red blood cell （RBC）, platelet （PLT）, prothrombin time （PT） ,activated partial thromboplstin time （ APTT）, alveolar-arterial oxygen partial pressure [ P （A-a） 02 ], oxygenation index （OI） and vigileo mo- nitoring indicators after red blood cell composition transfusion before and after surgery and wound healing time, days of hospitalization and ICU transferred rate, through the establishment of blood transfusion-effectiveness of assessment criteria, to evaluate the efficacy and safety of the blood cell infusion in orthopedic elderly patients. Results Two sets of statistical efficiency of 59.3% and 72. 2% respectively, no signifi cant statistical difference between the two （ P 〉 0. 05 ）. Compared with the traditional red blood cell infu- sion group, the method goal-orientod by Hb and Hct of red blood cell infusion group with higher RBC, Hb and Hct, decreased PT, AFFF, shorter wound healing time, ICU transferred rate decreased （ P 〈 0.05 ）. Conclusion The method goal-oriented by Hb and Hct of red blood cell infusion will be more effective to improve the effectiveness of perioperative red blood cell infusion for orthopedics in elderly patients.