限制性输血联合高压氧预处理对THA、TKA围术期临床疗效的研究

A Study on the Perioperative Clinical Efficacy of Restrictive Blood Transfusion Combined with Hyperbaric Oxygen Preconditioning on the THA and TKA

目的:比较限制性输血联合高压氧预处理(HBOPC)和单纯限制性输血对髋、膝关节置换术(THA、THA)的围术期临床疗效。方法:选择择期在硬膜外麻醉、股神经阻滞下行髋、膝关节置换术患者40例,随机分为两组:限制性输血组(维持80 g/L≤Hb<100g/L,n=20)和限制性输血联合HBOPC组(HBOPC+维持80 g/L≤Hb<100 g/L,n=20)。比较两组的红细胞输注量、红细胞输注率、围术期Hb、血氧饱和度(SO2)、术中低血压发生率、住院时间以及术后患者脑梗死、急性肺栓塞、肺炎、心肌梗死、伤口感染发生率及90 d死亡率。结果:与限制性输血组比较,联合HBOPC组术后Hb、血氧饱和度(SO2)明显增加(P<0.05),红细胞输注量、红细胞输注率、肺炎发生率、伤口感染发生率明显降低(P<0.05)。结论:限制性输血联合高压氧预处理可改善髋、膝关节置换术患者缺氧状态、能有效减少红细胞输注、减少术后并发症,具有良好的临床疗效。

Objective： To compare the clinical effects of restrictive blood transfusion combined with hyperbaric oxygen preconditioning （HBOPC） and restrictive blood transfusion in the treatment of hip, knee arthroplasty （THA, THA）. Methods： 40 patients in the period of epidural anesthesia, femoral nerve hysteresis hip and knee arthroplasty were selected and randomly divided into two groups： restrictive transfusion group （maintain 80 g/L〈 Hb 〈100 g/L,n=20） and restrictive blood transfusion combined with HBOPC （HBOPC＋maintain 80 g/L = Hb 〈100 g/L, n=20）. The red blood cell transfusion, red blood cell transfusion rate, perioperative Hb, blood oxygen saturation （SO2）, the incidence of hypotension during operation, hospitalization time and postoperative cerebral infarction, acute pulmonary embolism, pneumonia, myocardial infarction, wound infection rate and 90 days mortality rate were compared between two groups. Results： Compared with the restrictive transfusion group, the postoperative Hb, blood oxygen saturation （SO2） of restrictive blood transfusion combined with HBOPC group were significantly increased（P 〈 0.05）; the red blood cell transfusion, red blood cell transfusion rate, incidence of pneumonia, wound infection rate were significantly decreased （P〈0.05）. Conclusion： Restrictive blood transfusion combined with hyperbaric oxygen preconditioning could improve the anoxic state of the hip, knee arthroplasty patients, which could effectively reduce red blood cell transfusion, reduce postoperative complications, has good clinical curative effect.