期刊文献+

膝关节置换围术期不同血液管理方法的效果比较及相关研究 被引量:5

Comparison and association studies of different perioperative blood management during total knee arthroplasty
下载PDF
导出
摘要 目的探讨全膝关节置换术(TKA)围术期应用促红细胞生成素(EPO)、氨甲环酸(TA)、和自体血回输3种血液管理方法的疗效。方法选取2013年5月至2014年12月在首都医科大学宣武医院行TKA的患者,采用数字表法将全部患者随机分为EPO组、TA组、自体血回输组和空白对照组,4组患者围术期采取不同的血液管理方法。比较患者术后Hb、异体输血、失血等数据,并计算隐性失血量,进行统计学分析。结果共纳入108例患者,男20例,女88例;平均年龄(70.6±6.4)岁;BMI(26.97±3.51)kg/m^2。EPO组31例,TA组28例,自体血组28例和空白对照组21例。对照组围术期Hb变化差值(43.7±8.2)g/L大于其他3组(36.8±13.6)、(35.0±8.7)、(27.1±14.8)g/L,差异有统计学意义(P<0.05);EPO组、TA组、自体血回输组和对照组术后异体血输注率分别为19.4%、7.1%、32.1%和28.6%,TA组异体输血率显著少于其他3组,差异均有统计学意义(P<0.05);自体血组总失血量(1 536±438)ml,对照组(1 476±263)ml,明显多于EPO组[(1 179±378)ml]和TA组[(1 057±242ml)],差异有统计学意义(P<0.05)。结论应用EPO、TA、自体血回输3种血液管理方法均可以有效改善TKA的失血情况。3种方法中,TA可获得相对较好的疗效,但由于TKA失血较多,建议联合多种血液管理方法。 Objective To study the effect of three perioperative blood management approaches on perioperative blood loss during total knee arthroplasty(TKA). Methods A total of 108 patients who underwent TKA due to osteoarthritis were enrolled from May 2013 to December 2014. Patients were divided into four groups randomly using the number table:the EPO group, the TA group, the blood salvage group and the control group. Different perioperative blood managements were used in each group. The volume of drained blood and Hb levels postoperatively were measured. The number of patients requiring blood transfusion were recorded and compared. The perioperative hidden blood loss was calculated, then the total and hidden blood loss were compared. Results A total of 108 patients were enrolled in the study,20 were males, 88 were females; and the average age was (70.6±6.4)years old; BMI was (26.97±3.51 )kg/m2. There were 31 cases in the EPO group, 28 cases in the TA group, 28 cases in blood salvage group, 21 cases in the control group. In the control group, the postoperative Hb decreased (43.7±8.2)g/L, which was significantly higher than that in the other 3 groups (36.8± 13.6 ), (35.0±8.7), ( 27.1±14.8 ) g/L (P 〈 0.05 ). Blood transfusion rate of the TA group ( 7.1% ) was significantly lower than that of the other 3 groups( 19.4%, 32.1%, 28.6%; P 〈 0.05). Total blood loss in blood salvage group[( 1 536±438)ml] and control group[ ( 1 476±263)ml ] were more than EPO group[ ( 1 179±378)ml] and TA group [ ( 1 057±242)ml, ( 1 179±378) ml; P 〈 0.05 )]. Conclusion There is a large volume of peri-operative blood loss in TKA, the application of EPO, TA, and autologous blood transfusion can effectively alleviate the symptoms of anemia associated with TKA. TA get relatively bet- ter efficacy, but due to blood loss of TKA, so combined approaches are recommended for blood management.
出处 《北京医学》 CAS 2017年第7期704-707,共4页 Beijing Medical Journal
关键词 全膝关节置换术 围术期血液管理 隐性失血 氨甲环酸 促红细胞生成素 自体血 total knee arthroplasty(TKA) perioperative blood management hidden blood loss tranexamic acid erythropoietin(EPO) blood salvage
  • 引文网络
  • 相关文献

参考文献2

二级参考文献13

  • 1陶坤,吴海山,李晓华,钱齐荣,吴宇黎,祝云利,储小兵,徐长明.闭式引流在全膝关节置换术中的作用评价[J].中华外科杂志,2006,44(16):1111-1114. 被引量:32
  • 2万斌,吕征,吕天润.人工膝关节置换术后早期主动伸屈膝关节对康复速度的影响[J].实用老年医学,2007,21(5):323-325. 被引量:16
  • 3Zhang QD, Guo WS, Zhang Q, et al. Comparison between closed suction drainage and nondrainage in total knee arthro- plasty : a meta-analysis [ J ]. J Arthroplasty, 2011,26 ( 8 ) : 1265-1272.
  • 4Gross JB. Estimating allowable blood loss: corrected for dilu- tion[ J]. Anaesthesiology, 1983,58 (3) : 277-280.
  • 5Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account [ J ]. Knee, 2000,7(3) : 151-155.
  • 6Banerjee S, Kapadia BH, Issa K, et al. Postoperative blood loss prevention in total knee arthroplasty [ J ]. J Knee Surg, 2013,26(6) :395-400.
  • 7Holt BT, Parks NI, Engh GA, et al. Comparison of closed suction drainage and no drainage after pirmary total knee ar- throplasty [ J ]. Orthopedics, 1997, 20 ( 11 ) : 1121-1125.
  • 8Walmsley P J, Kelly MB, Hill RM, et al. A prospective, ran- domised,controlled trial of the use of drains in total hip ar- throplasty [ J ]. J Bone Joint Surg ( Br), 2005, 87 (12) : 1397-1401.
  • 9Huang Z, Ma J, Pei F, et al. Meta-analysis of temporary versus no clamping in TKA [ J ]. Orthopedics, 2013,36 (7) : 543-550.
  • 10吴宁,钱晓明.促红细胞生成素非造血作用临床应用研究进展[J].中国误诊学杂志,2008,8(2):272-274. 被引量:5

共引文献14

同被引文献29

引证文献5

二级引证文献13

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部