隐性失血在老年患者初次单侧全膝关节置换围手术期的分析

Analysis of hidden blood loss after primary total knee arthroplasty in the aged

目的分析老年患者初次单侧全膝关节置换(TKA)围手术期隐性失血的情况。方法选择自2013年6月~2015年12月行单侧TKA治疗的93例患者,男31例,女62例,年龄59~78岁,平均70.3岁,病程7~16年,平均9.4年,骨关节炎69例,类风湿关节炎24例。手术由同一组人员完成,采用相同术式操作。结果全部未采取自体血回输技术,术中出血量(71±17)mL,术后引流量(504±106)mL,隐性失血量(698±91)mL,总失血量(1307±112)mL,隐性失血占总失血量54.8%。78例术后输红细胞混悬液改善贫血(509±134)mL,输血率为83.9%。结论隐性失血是影响TKA患者围手术期安全的重要因素,手术评估出血量时充分考虑到隐性失血的存在,以便积极、主动采取对策恢复患者有效血容量,保证围手术期安全,利用患者早日康复。

Objective To analyze the hidden blood loss following primary total knee arthroplasty （TKA） in the aged. Methods The 93 patients were treated with unilateral total knee arthroplasty （TKA） in our hospital from Jun 2012 to Dec 2015, including 31 males and 62 females with an average of 70.3 years （rang, 59 to 78）, the course of illness ranged from 7 to 16 years, an average of 9.4 years, in which 69 patients with osteoarthritis, 24 cases with rheumatoid arthritis. All operations were operated by the same surgical physician using the same surgeon, Results All the patients were not transfused with autologous blood intraoperatively. Intra-operative blood loos was （71± 17）mL and post-operative drainage volume was （504±106） mL. The total blood loss was （1307±112） mL including hidden blood loss of （698±91） mL （54.8%）. 78 cases of postoperative losed red cell suspension liquid of improving anemia （83.9%）. Conclusion Hidden blood loss is an important factor that affects the prognosis of the patients treated by TKA. In order to secure their safety in perioperalive period and benefit their recovery, assessment of the amount of bleeding in TKA should fully take the hidden blood loss into consideration and prompt treatment measures should be taken to fully and effectively recover their effective circulaion blood volume.