老年患者全膝和全髋关节置换术围手术期血红蛋白及红细胞压积的转归

Natural outcome of hemoglobin and hematocrit in elderly patients without allogeneic blood transfusion after total knee and hip arthroplasty

目的 探讨非输血老年患者全膝和全髋关节置换术围手术期血红蛋白及红细胞压积的自然转归及其与性别、手术类型之间的关系.方法 2012年9月至2013年2月接受全膝关节或全髋关节置换术的60岁以上骨关节炎患者107例,男54例,女53例;年龄60～82岁,平均69.4岁.检测术前、手术日、术后第1～7天,3周、6周、3个月、6个月的血红蛋白和红细胞压积,分析其变化趋势.将不同性别和手术类别各个时点的血红蛋白和红细胞压积进行比较,评价性别和手术类别对血红蛋白和红细胞压积转归的影响.结果 所有患者血红蛋白和红细胞压积均于术后至第4天出现明显下降,最低点出现在术后第4天,术后1周至3周,血红蛋白和红细胞压积回升最快,在术后6周至3个月逐渐恢复到术前水平.在下降和恢复过程的各个时点,男性与女性患者的血红蛋白、红细胞压积差异无统计学意义.全髋关节置换组术后第4天内血红蛋白下降多于全膝关节置换组,全髋关节置换组手术日红细胞压积下降多于全膝关节置换组,差异均有统计学意义,其他时点两组血红蛋白和红细胞压积下降值的差异无统计学意义.结论 全膝和全髋关节置换术后血红蛋白和红细胞压积的最低点出现在术后第4天,术后6～12周恢复.性别因素对围手术期失血及恢复无明显影响.全髋关节置换术后血红蛋白和红细胞压积下降多于全膝关节置换.

Objective To explore the natural outcome of perioperative hemoglobin and hematocrit of elderly patients undergoing TKA or THA without blood transfusion and evaluate the influence of gender and type of arthroplasty on it.Methods This is a cohort study on 107 patients with osteoarthritis and more than 60 years of age receiving TKA or THA without allogeneic blood transfusion from September 2012 to February 2013.There were 54 males and 53 females with a mean age of 69.4 years （range：60-82）.Levels of hemoglobin and hematocrit were examined preoperatively immediately after surgery and on postoperative day 1-7 during hospitalization.After being discharged from the hospital,patients were followed up by clinic visit at the 3rd week,the 6th week,the 3rd month and the 6th month after surgery.Blood test was performed to examine the levels of hemoglobin and hematocrit.Based on gender and type of arthroplasty,the levels of hemoglobin and hematocrit at every time point were compared with each other.The influence of gender and type of arthroplasty on levels of hemoglobin and hematocrit was further evaluated.Results Levels of hemoglobin and hematocrit of all patients significantly decreased postoperatively and reached the minimum values on postoperative day 4.From postoperative week 1 to 3,levels of hemoglobin and hematocrit rebounded the fastest.Levels of hemoglobin and hematocrit rebounded to their preoperative levels within postoperative 6-12 weeks.No significant difference in levels of hemoglobin and hematocrit was found between groups with different genders.Patients undergoing THA had significantly greater drop in the level of hemoglobin than those undergoing TKA in the first 4 days postoperatively （P〈0.05）.Patients undergoing THA had significantly greater drop in the lcvcl of hcmatocrit than those undergoing TKA in the operation day （P〈0.05）.No significant difference was found at other time points between patients receiving THA and TKA.Conclusion Levels of hemoglobin and hematocrit decreased during the first 4 days after arthroplasty and gradually returned to normal values within postoperative 612 weeks.Gender had no influence on the natural outcome of perioperative hemoglobin and hematocrit.Patients undergoing THA had more postoperative blood loss than those undergoing TKA.