髋关节手术异体红细胞输注概况分析

Analysis of allogeneic blood transfusion following total hip arthroplasty

目的回顾性分析近年来髋关节手术的临床病例资料,评价髋关节手术输血治疗现状。方法选取1999-2015年在本院进行髋关节手术病例共4 250例,描述平均住院日变化趋势,计算进行异体输血治疗的患者比例,术中红细胞平均输注量,单/双髋关节手术围术期的红细胞平均输注量;并将其分为异体红细胞治疗组(去白细胞红细胞组/悬浮红细胞组)与未输注红细胞治疗组,分别评价组别之间输注红细胞后的指标变化。结果 4 250例进行髋关节手术的患者中,进行输血治疗的比例为55.72%,术中进行输血治疗患者的红细胞平均输注量为3.17±1.27 U;自1999-2015年间,各年的平均住院日整体呈现下降趋势;各年的输血患者比例约在40%-70%之间,以2013年最高;术中红细胞平均输注量在2000年达到最大值,之后逐渐下降;单/双髋关节手术围术期的红细胞平均输注量分别在2009/2010年达到最大,之后均逐年下降。红细胞输注后的白细胞计数变化值在输血组与非输血组别之间具有统计学差异,而在输注去白细胞红细胞组和悬浮红细胞组别之间不具有统计学差异。结论近年来,髋关节手术患者的平均住院日、红细胞平均输注量均呈下降趋势,输血治疗的比例维持在一定范围内;输血可能导致术后感染率升高。

Objective To evaluate the current situations associated with allogeneie blood transfusion following THA. Methods A total of 4 250 patients from PLAGH, during 1999 to 2015, were collected. Their mean length of stay, transfusion rate, mean transfusion dosages, the differences of mean transfusion dosages between unilateral/bilateral THA in perioperative period were obtained. All the clinical data were divided into transfusion （leukocyte-reduction RBC and RBC）, non- transfusion groups, and the indicator changes after transfusion were evaluated. Results The rate of transfusion following THA was 55.72% of all patients. The mean transfusion dosage was 3. 17 ＋- 1.27 units. During 1999 - 2015 period, the mean length of stay decreased gradually. The transfusion rate was between 40% -70% approximately, and the year 2013 had the highest transfusion rate. Year 2000 had the highest mean transfusion dosage and decreased year by year. Year 2009 and 2010 had the most RBC transfusion dosages of unilateral and bilateral hip arthroplasty, respectively. The changes of leu- kocyte count after transfusion were statistically significant between transfusion and non-transfusion groups, while the changes were not statistically significant between leukocyte-reduction RBC and RBC groups. Conclusion The mean length of stay and mean transfusion dosage of THA decreased, while the blood transfusion rate kept within the range. Transfusion may re- sult in increased rate of infection.