双侧全膝关节置换术后输血的危险因素分析

Risk factors of blood transfusion after total knee arthroplasty

目的研究影响初次同期双侧全膝关节置换术后输血治疗的危险因素。方法 2014年2-12月本院收治的125例行初次双膝关节置换术患者,根据术后是否输血治疗分为输血治疗组（治疗组,n=49）和非输血治疗组（对照组,n=76）。单因素及Logistic回归分析筛选与输血治疗有关的危险因素。结果单因素分析显示,术前凝血酶原时间（prothrombin time,PT）（P=0.012）、术前活化部分凝血酶时间（activated partial thromboplastin time,APTT）（P=0.011）、手术时间（P〈0.000 1）、术后1 d的血红蛋白（hemoglobin,Hb）下降百分率（P〈0.000 1）与术后输血治疗显著相关,多因素Logistic回归分析显示,手术时间（OR：1.094,95%CI：1.054-1.135,P=0.000）、术后1 d的Hb下降百分率（OR：1.122,95%CI：1.063-1.185,P=0.000）、术前APTT（OR：1.191,95%CI：1.042-1.362,P=0.010）与术后输血治疗显著相关。结论行同期双侧全膝关节置换术患者术前APTT、手术时间、术后1 d的Hb下降百分率是术后输血的危险因素,通过及时对这些因素的评估有助于预防和减少术后贫血的发生。

Objective To study the risk factors of postoperative blood transfusion in patients undergoing bilateral total knee arthroplasty（TKA）. Methods One hundred and twenty-five patients（250 knees） who underwent bilateral TKA in our hospital from February to December in 2014 were divided into two groups： transfusion treatment group（n=49） and non transfusion treatment group（n=76）, according to whether patients had undergone transfusion treatment or not after surgery. Risk factors related to the transfusion treatment were analyzed by single factor and logistic regression analysis. Results Single factor analysis showed that preoperative prothrombin time（PT, P=0.012）, preoperative activated partial thromboplastin time（APTT, P=0.011）, surgery time（P 〈0.000 1）, postoperative 1 d D-value Hb%（P〈 0.000 1） were correlated with postoperative transfusion treatment significantly, multivariate logistic regression analysis showed that surgery time（OR： 1.094, 95% CI： 1.054-1.135, P=0.000）, postoperative 1d D-value Hb%（OR： 1.122, 95% CI： 1.063-1.185, P=0.000）, preoperative APTT（OR： 1.191, 95% CI： 1.042-1.362, P=0.010） were correlated with postoperative transfusion treatment significantly. Conclusion The preoperative APTT, surgery time and postoperative 1 d D-value Hb% of the patients with bilateral TKA are risk factors for postoperative transfusion treatment, timely assessment of these factors is preferred so as to prevent and reduce the occurrence of postoperative anemia.