自体红细胞回输在髋关节置换术患者中的应用价值

Application value of autologous red blood cell transfusion in the patients with hip replacement

目的 ：探讨自体红细胞回输在髋关节置换术患者中的应用价值。方法 ：选取我院2014年1月至2015年1月期间骨科住院部收治的髋关节置换术患者89例,采用随机数字表法将患者分为观察组（45例）和对照组（44例）,当术中血红蛋白（hemoglobin,Hb）〈6.5 g/dl或红细胞比容（hematocrit,Hct）〈25%时,对照组补充库存血,而观察组采用自体红细胞回输,比较两组Hb水平、Hct水平、术中出血量、异体血输入量和手术时间、免疫功能指标（CD4＋、CD8＋）水平和并发症发生率的差异。结果 ：麻醉前（T0）、术中1 h（T1）两组患者Hb和Hct水平比较差异无统计学意义（P〉0.05）,手术结束时（T2）观察组Hb和Hct水平均明显高于对照组（P〈0.05）,两组手术时间和术中出血量比较差异无统计学意义（P〉0.05）,观察组异体血输入量均明显低于对照组（P〈0.05）,麻醉前,两组患者CD4＋和CD8＋水平比较差异无统计学意义（P〉0.05）,手术后2~5 d,观察组患者CD4＋和CD8＋水平明显高于对照组（P〈0.05）,而对照组CD4＋和CD8＋水平明显低于麻醉前（P〈0.05）,两组患者输血相关性并发症发生率比较差异无统计学意义（P〉0.05）。结论 ：自体血回输有助于改善髋关节置换术患者血红蛋白和红细胞比容水平,降低异体血输入量和改善免疫功能,值得临床推广应用。

Objective： To study the value of autologous red blood cell transfusion for hip replacement patients. Methods： Eighty-nine cases of hip replacement patients from orthopedic inpatient in our hospital from January, 2014 to January, 2015 were selected and divided into an observation group（n=45） and a control group（n=44） by using the random number table method. When hemoglobin（Hb） or hematocrit（Hct） was less than 6.5 g/dl or 25%, homologous blood transfusion was given in the control group while only autologous red blood cell transfusion in the observation group. The levels of Hb and Hct, the intraoperative blood loss and the volume of homologous blood transfusion, time for operation, the levels of immune function indexes（CD4＋, CD8＋） and the incidence of complications were compared between two groups. Results：, Hb and Hct levels had no statistically significant difference before anesthesia（T0） and 1 h（T1） during operation（P〉0.05）, Hb and Hct levels at the end of surgery（T2） were significantly higher in the observation group than in the control group（P〈0.05）. The time for operation and intraoperative blood loss had no statistical significance（P〉0.05）, however, the volume of homologous blood transfusion was significantly lower in the observation group than in the control group（P〈0.05）. The levels of CD4＋ and CD8＋ had no statistically significance（P〉0.05） before anesthesia and were obviously higher in the observation group than in the control group（P〈0.05） 2 ~ 5 days after the surgery and were obviously lower in the control group compared with those of pre-anesthesia（P〈0.05）. The complications related to blood transfusion between two groups had no statistically significance（P〉0.05）. Conclusion：Autologous blood transfusion is of benefit to improving Hb and Hct levels in the patients with hip replacement, reducing homologous blood transfusion and improving immune function, and worthy of clinical popularization and application.