髋关节置换术围术期输血相关信息的调研分析

Retrospective analysis of perioperative bloodtransfusion-associated factors inhip arthroplasty

目的探讨髋关节置换术围术期输血的影响因素,为加强单病种患者血液管理、建立髋关节置换术围术期输血评价标准提供数据基础。方法收集大连地区2家三级甲等医院接受髋关节置换术患者275例,根据是否输注异体血分为输血组（45例）和未输血组（230例）;收集275例实施髋关节置换术患者的基本信息（性别、年龄、临床诊断）、手术相关信息（手术时间、术中失血量）、血常规（包括术前、术中、术后）、凝血功能指标（包括术前、术中、术后）、患者转归情况（抗生素使用情况、住院天数）进行统计学分析。结果髋关节置换术患者围术期输血比例为16. 4%,患者人均用血量0. 6±1. 6 U。输血组和未输血组在手术时间、术中失血量、术前Hb、术后Hb、术后Plt、术前APTT、术前Fbg、住院天数方面差异有统计学意义（P〈0. 05）。患者围术期输血量与手术时间、术中失血量、术前Hb和术后Hb有相关性,相关系数r分别为0. 006、0. 002、-0. 012和-0. 014（P〈0. 05）。结论髋关节置换术患者围术期输血量与手术时间和术中失血量成正相关,与术前Hb和术后Hb呈负相关。对髋关节置换术患者,应通过采取提高患者术前血红蛋白浓度、减少术中和术后失血量、规范手术操作、开展血液保护等有效措施减少不必要的输血。

Objective To explore factors of perioperative blood transfusion in total hip replacement to enforce patient blood management and provide information for assessment standard establishment of blood transfusion in hiparthroplasty.Methods 275 patients with hiparthroplasty from two hospitals in Dalian were enrolled and divided into two groups： The transfusion group（ 45 cases） and the non-transfusion group（ 230 cases）. Patient information including age,gender,diagnosis,time of operation,bleeding volume during operation,antibiotics treatment and hospitalizationperiod were analyzed as well as hemoglobin level（ Hb）,platelet count（ PLT）,activated partial thromboplastin time（ APTT） and Fibrinogen（ Fbg） before and after surgery.Results 16. 4% of patientswithhiparthroplasty had transfusion during the perioperative period and the average blood transfusionvolume was 0. 6±1. 6 Units. There were significantdifferences inoperation duration,bleeding volume during operation and hospitalizationperiod between the transfusion and non-transfusion group（ P〈0. 05）. Hbof pre-and post-operation,APTT and FBG of pre-operation,PLT of post-operationalso showed significant differences between the two groups（ P〈0. 05）. Transfusion volume was clearly correlated with operation duration,bleeding volume during operation and Hb before and after surgery. The correlation coefficients were 0. 006、0. 002、-0. 012 and-0. 014,respectively（ P〈0. 05）. Conclusion Transfusion volume was positively correlated with operation duration and bleeding volume in operation,but negatively correlated with Hbof pre-and post-operation. Increasing Hbpre-operation,reducing bleeding volume during operation and postoperation,standardizing operation procedure,using the techniques of blood conservation and other effective measures coulddecrease unnecessary blood transfusion during treatment.