髋关节置换术患者输血合理性的初步调查

A Primary Survey of Blood Transfusion Rationality for Hip Replacement Patients

目的调查髋关节置换术输血的合理性,从而提高医院临床用血的管理。方法某院2016年1月-2月髋关节置换术10例患者的输血情况。患者均采用腰硬联合麻醉和单侧股骨头置换术。术中常规使用血液回收机,术终回输自体RBCs。术后输血与否和输RBCs单位数均由骨科医师决定。输血合理性分为三类:(1)零输血;(2)合理输血;(3)欠合理输血。结果 2例为零输血,4例为合理输血,4例为欠合理输血。4例欠合理输血中,1例因输1U RBCs后发生寒战而终止输血,术后Hb为117g/L,属于超输。结论髋关节置换术应减少不必要的输血。术前Hb>120g/L者可免输血,Hb<120g/L者需合理输血。术后Hb在80g-90g/L之间是安全的。

Objective To investigate the rationality of the hip replacement blood transfusion,so as to improve the management of hospital clinical use.Methods Ten hip replacement patients with blood transfusion in Jan and Feb 2016 were analyzed.They had all done femoral head replacements received spinal-epidural anesthesia.Intraoperative blood salvage was routinely used and autologous RBCs returned back to all patients.The blood transfusion trigger of allogeneic RBCs and unite numbers were decided by the orthopedic surgeons.The postoperative transfusion nationality is classified into three categories：（1） no transfusion;（2）reasonable transfusion;（3） lack of reasonable transfusion. Results There was no blood transfusion in two case, reasonable transfusion and lack of reasonable transfusion in four cases, respectively. Transfusion was interrupted in one case because of chill following 1U RBCs transfused hut his postoperative Hb was at 117g/L. Conclusion Unilateral artificial femoral head replacements for femoral neck fracture were performed in ten cares, 9 cases is over 70 years old. The blood transfusion for hip replacement should be reasonable to reduce unnecessary transfusion, Preoperative Hb120g/l should not be as blood transfusion, Preoperative Hb〈120g/l should be as reasonable blood transfusion.Postoperative Hb between 8~10g/dl is a safe level.