老年髋部骨折围手术期限制性输血与开放性输血疗效对比研究

Comparative study on the efficacy of restrictive and liberal transfusion strategies for red blood cell transfusion during perioperation in elderly patients with hip fracture

目的观察限制性与开放性输血对老年髋部骨折手术疗效及预后的影响。方法选择年龄>65岁老年髋部骨折并行手术治疗患者100例,ASA分级Ⅰ—Ⅲ级,排除慢性贫血等因素,随机分为A、B 2组:限制性输血组(A组,n=50):围手术期Hb<80 g/L即启动输红细胞;开放性输血组(B组,n=50):围手术期Hb<100 g/L再启动输红细胞,观察记录手术时间等各项指标。结果 A组与B组比较手术时间、术中低血压发生率、围手术期失血量、术后伤口感染发生率、拆线时间、住院天数、出院3个月后Hb及直立行走率无差异(P>0. 05),但在输血量(1. 80±1. 32vs 4. 25±1. 18)、输血不良反应发生率(0%vs 12%)、输血相关费用(298. 70±255. 12 vs 1 309. 30±292. 74)及出院前24h内Hb(92. 90±5. 49 vs 104. 30±3. 86)方面明显低于开放性输血组(P<0. 05)。A组术中和术后输血量明显低于B组(0. 54±0. 74 vs 2. 09±0. 37;1. 24±0. 90 vs 2. 15±0. 92,均为z<0. 05),术前2组输血量比较无差异(P>0. 05)。A组和B组中入院Hb和出院3个月后Hb比较无差异(P>0. 05);但出院前24 h内Hb均明显低于入院Hb和出院3个月后Hb(P<0. 05))。结论对老年髋部骨折行手术治疗患者,限制性输血安全有效,不影响患者预后,在输血后不良反应及节约用血方面显著优于开放性输血,值得临床推广。

Objective To observe surgical prognosis effects of restrictive and liberal transfusion strategies for red blood cell transfusion in the elderly hip fracture.Methods A total of 100 elderly patients with hip fracture(aged more than 65 years old)and ASA gradeⅠ—Ⅲ,excluding chronic anemia and other factors,were randomized into two groups(50 patients/group)for transfusion according to Hb concentrations before surgery:restrictive blood transfusion(group A,the transfusion trigger was Hb<80 g/L),and liberal blood transfusion(group B,the transfusion trigger was Hb<100 g/L),then the surgical time and other indicators were observed and recorded.Results There were no differences in the surgical time,the incidence of hypotension intraoperative,blood loss volume during perioperation,the incidence of wound infection,the time to remove stitches,inpatient days,Hb levels and the incidence of walking upright after leaving hospital after three months(P>0.05)between group A and group B.But the amount of RBC transfusion(1.80±1.32 vs.4.25±1.18),rate of adverse transfusion reaction(0%vs.12%),transfusion expenses(298.70±255.12 vs.1 309.30±292.74)and Hb levels 24 hours before leaving hospital(92.90±5.49 vs.104.30±3.86)in group A were obviously lower than that of group B(P<0.05).The amount of blood transfusion in group A was significantly lower than group B during and after surgery(0.54±0.74 vs.2.09±0.37;1.24±0.90 vs.2.15±0.92,both z<0.05),but there was no difference between two groups before surgery(P>0.05).There were no differences in Hb levels between admission and 24 hours before leaving hospital in the group A and B,but Hb levels 24 hours before leaving hospital were obviously lower than that at admission and leaving hospital after three months.Conclusion Restrictive blood transfusion can reduce adverse transfusion reaction,save blood resources,and produce no effect on the prognosis of patients.So it is valuable of clinical application for the elderly hip fracture surgery patients.