自体血回输对四肢近端多发闭合性骨折患者的影响

Effect of autologous blood transfusion on patients with multiple proximal limb fractures

目的探讨自体血回输对四肢近端多发闭合性骨折患者的影响。方法 2015年2月—2017年8月陆军军医大学第一附属医院收治四肢近端多发闭合性骨折患者90例,男性65例,女性25例;年龄18～50岁,平均35. 5岁。按照随机数字表法分为两组,各45例。所有入组患者在消除急性期水肿、生命体征平稳后,择期于全身麻醉气管插管下实施手术治疗,根据术中出血情况,分为外源性浓缩红细胞补充组(补充组),自体血回收组(回收组)。回收组:男性32例,女性13例;年龄18～50岁,平均35. 6岁;补充组:男性33例,女性12例;年龄18～50岁,平均35. 5岁。比较患者离开手术室时,其血常规结果中,血红蛋白、血小板及红细胞压积变化情况,凝血功能相关指标中凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)变化情况,干预后pH值、钾离子与钠离子水平,统计两组出现的围术期循环系统相关并发症。结果干预后,回收组血常规相关指标中血红蛋白、血小板及红细胞压积分别为(10. 5±1. 1) g/L、(158. 8±5. 9)×10~9/L、(39. 6±2. 4)%均显著高于补充组的(8. 6±0. 9) g/L、(114. 6±3. 8)×10~9/L、(28. 7±1. 6)%,两组比较差异有统计学意义(P <0. 05),干预后回收组凝血功能相关指标中PT、TT、APTT分别为(13. 7±1. 1) s、(11. 1±2. 4) s、(21. 6±1. 3) s均短于补充组的(23. 6±1. 3) s、(21. 6±2. 5) s、(41. 7±1. 9) s,两组比较差异有统计学意义(P <0. 05),FIB水平(1. 7±0. 1) g/L高于补充组(1. 2±0. 1) g/L,两组比较差异有统计学意义(P <0. 05),回收组pH值、回收组钾离子和钠离子水平均基本正常,且pH值高于补充组[(7. 38±0. 01) vs.(7. 32±0. 01)],钾离子低于补充组[(4. 1±0. 2) mmol/L vs.(5. 6±0. 3) mmol/L],两组比较差异有统计学意义(P <0. 05),回收组围术期循环系统出现的相关并发症中,如低血压、凝血功能障碍、心率增快及麻醉苏醒延迟等比例显著低于补充组(P <0. 05)。结论针对四肢近端多发闭合性骨折而无法在术中使用止血带者,术中行自体血回收术,能有效地维持患者血常规与凝血常规稳定,保持内环境平衡,减少麻醉、手术对循环功能影响,提高治疗安全性。

Objective To investigate the effect of autologous blood transfusion on patients with multiple proximal limb fractures. Methods A total of 90 patients with multiple proximal closed fractures of the extremities were enrolled from Feb. 2015 to Aug. 2017. They were divided into two groups according to random number method,with 45 cases in each group. The recycling group had 32 males and 13 females aged of 18-50 years old （average,35.6 years old）. The supplement group had 33 males and 12 females aged 18-50 years （mean,35.5 years old）. All patients underwent elective surgery under the general anesthesia tracheal intubation after acute phase of edema managed and the vital signs were stable. According to intraoperative bleeding,the control group （recycling group） applied for exogenous enrichment of red blood cells. The observation group （supplement group） received autologous blood recovery. The patients blood pressure results,hemoglobin,platelet and hematocrit changes,coagulation function when left the operating room were compared. The changes of PT,TT,APTT,and FIB in related indicators,and the levels of pH,potassium,and sodium ions after intervention,and the complications related to circulatory system in the two groups were counted. Results After intervention,hemoglobin,platelet and hematocrit in the blood-related indexes of the observation group were significantly higher than that those in the control group（ P 〈0.05）. PT,TT,and APTT in the coagulation-related indexes of the observation group were shorter than those in the control group after the intervention（ P 〈0.05）,and FIB level was higher than that in the control group（ P 〈0.05）. The pH value,potassium ion and sodium ion level in the observation group were basically normal,pH value was higher than that of the control group,and potassium ion was lower than that in the control group（ P 〈0.05）. The incidence of complications associated with the perioperative circulatory system in the observation group,such as hypotension,coagulation dysfunction,increased heart rate,and delay in anesthesia resuscitation was significantly lower than that in the control group（ P 〈0.05）. Conclusion The autologous blood transfusion technique for patients with multiple proximal limb fractures can effectively maintain blood routine and coagulation routine stability,maintain internal environment balance,reduce the influence of anesthesia and surgery on circulation function,and improve treatment safety.