人工全膝关节置换术后异体输血的危险因素分析

Risk factors associated with allogeneic blood transfusion in primary total knee arthroplasty

目的调查人工膝关节置换术后异体输血率,并且探讨影响异体输血的危险因素,为在临床上降低异体输血率提供参考。方法回顾性分析2013年1月-2013年12月在本中心进行的全部初次人工全膝关节置换术的输血状况,收集了若干术前、术中以及术后因素用以评估对术后异体输血需求的影响。利用统计学软件对上述因素进行单因素分析和Logistic回归分析。结果总共完成单膝关节置换术846例,双膝关节同时置换术120例;异体输血率为91.5%,其中709名患者只输异体血,37名患者只输自体血,175名患者两者都输。单因素分析结果显示,年龄、性别、置换类别、止血带使用、自体输血、医生手术量等比较;Logistic多因素回归分析结果显示,置换类别、止血带使用、自体输血等比较,均为P<0.01。结论本研究中的人工膝关节置换术后异体输血率较高,警示我们需要严格掌握输血指征,合理用血。应用术前预存自体血、术中不使用止血带以及进行单膝置换有助于降低术后异体输血的需求。

Objective To determine allogeneic blood transfusion rate and to analyze associated risk factors associated in primary total knee arthroplasty. Methods All of the primary total knee arthroplasty cases performed in our department from January to December 2013 were reviewed retrospectively. The rate of allogeneic blood transfusion was calculated and several associated perioperative risk factors were assembled for evaluation. Data collected were identified by univariate analysis and multivariate logistic regression model. Results There were 846 unilateral knee arthroplasty and 120 bilateral knee arthroplas- ty eases. The rate of allogeneic blood transfusion was 91.5%. 709 patients received only allogeneic blood transfusion, 37 pa- tients received only predonated autologous blood, and 175 patients received both of them. Univariate analysis demonstrated that the risk of allogeneie blood transfusion is affected by age （ P = 0. 035 ）, gender （ P = 0. 008 ）, type of arthroplasty （ P = 0. 012 ）, tourniquet use （P = 0. 000）, predonated autologous blood transfusion （P = 0. 000） and surgical case volume （P = 0. 030）. Multivariate logistic regression model revealed that the types of arthroplasty （P = 0. 013 ） , tourniquet use （P = 0. 000 ） and predonated autologous blood transfusion （P = 0. 000） are strongly predictive indicators on the need for allogeneic transfusion. Conclusion The rate of allogeneic transfusion was high in this study, implying that stringent transfusion proto- cols should be taken . Predonated autologous blood transfusion, unused tourniquet and unilateral total knee arthroplasty are beneficiary to decrease the need for allogeneie transfusion.