髋、膝关节置换术后老年患者显、隐性失血情况及输血策略研究

Exploration of the dominant and recessive loss of blood and blood transfusion strategies in elderly patients undergoing hip(knee) joint replacement

背景:髋、膝关节置换术在髋、膝损伤的老年患者中应用广泛,不过术后患者多伴有贫血症状,贫血导致伤口愈合慢,易感染等,不利于患者的康复。目的:探讨行髋、膝关节置换术的老年患者术后显、隐性失血情况及输血策略。方法:选择2014年4月至2016年8月我院骨科收治的拟行单侧髋、膝关节置换术的老年患者96例,均符合单侧髋、膝关节置换术适应证且为初次手术,分为单侧髋关节置换术组(髋关节组)44例,其中,24例为肥胖患者,均未采用引流血回输系统;单侧膝关节置换术组(膝关节组)52例,其中,29例为肥胖患者,19例采用引流血回输系统。通过Gross方程着重计算两组的实际总失血量、显性与隐性失血情况,探讨隐性失血机制,并制定相应的输血策略。结果:髋关节组隐性失血占实际失血总量的31.5%(477 ml/1512 ml),膝关节组隐性失血占实际失血总量的51.3%(769 ml/1499 ml),两组隐性失血量比较,存在统计学差异(P<0.05);髋关节组与膝关节组肥胖者与非肥胖者的隐性失血量比较,均不存在统计学差异(P>0.05);膝关节组引流血回输患者的实际失血总量高于未行血液回输患者(P<0.05)。结论:行全膝关节置换术患者的隐性失血量高于行全髋关节置换术患者,即使使用引流血回输亦达不到完全满足机体恢复循环的需要,需加强对患者血容量的补给,此外,正确认识隐性失血可提高临床评估能力,引导患者顺利度过围术期,尽早开展关节功能训练。

Background： The replacement of hip（knee） joint is widely used in elderly patients with knee and hip injury, however, after surgery most of patients have symptoms of anemia which causes slow healing of the wound, infections, and other diseases. and is not good for the patient＇s recovery. Objective： To explore the dominant and recessive loss of blood and blood transfusion strategies in elderly patients undergoing hip（knee） joint replacement. Methods： A total of 96 elderly patients hospitalized to receive unilateral hip（knee） joint replacement from April 2014 to August 2016 were selected, who had the indications of unilateral hip（knee） replacement and took the operation for the first time. All patients were divided into two groups： patients receiving unilateral hip replacement（the hip joint group, n=44）, including 24 obese patients,with no one using drainage blood auto transfusion system, and patients receiving unilateral knee replacement（the knee joint group,n=52）, including 29 obese patients, with 19 patients using drainage blood auto transfusion system. The actual total loss of blood, dominant and recessive blood loss in both groups were calculated through Gross equation, the mechanism of recessive blood loss was discussed and the corresponding strategy of blood transfusion was developed. Results： The recessive blood loss in patients of the hip joint group accounted for 31.5% of the actual total loss of blood（477 ml/1512 ml）, while that of the knee joint group accounted for 51.3% of the actual total loss of blood（769 ml/1499 ml）, and there was significant difference in recessive blood loss between the two groups（P〈0.05）.There was no significant difference in recessive blood loss between the obese patients and the non obese patients in both groups（P〉0.05）. The actual total loss of blood of patients using drainage blood auto transfusion was significantly higher than that of the patients without drainage blood auto transfusion in the knee joint group（P〈0.05）. Conclusions： The recessive blood loss of the patients undergoing total knee replacement is significantly higher than that of the patients undergoing total hip replacement. Even though they use drainage blood autotransfusion, it is still not enough to fully satisfy the body＇s need to restore circulation, and need to expend the supply of blood volume. In addition, the correct understanding of recessive blood loss is conducive to improving the ability of clinical A B evaluation, and guiding the patients to go through the perioperative period smoothly and carry out training of the joint function as early as possible.