肥胖对加速康复流程下全膝关节置换术围术期失血量的影响

Influence of obesity on perioperative blood loss following enhanced recovery after primary total knee arthroplasty

目的评价加速康复流程下肥胖对全膝关节置换术(TKA)围术期失血量的影响。方法回顾性分析2017年8月-2018年8月四川大学华西医院关节外科中心行初次单侧TKA的患者的临床资料,按照体重指数(BMI)分为正常组(18~<24 kg/m^2)、超重组(24~<28 kg/m^2)和肥胖组(≥28 kg/m^2),比较各组患者的基线资料、总失血量、术中输血量、隐性失血量、总失血量和血容量(PBV)的比值、异体输血率、血红蛋白和血细胞比容变化量、术后住院时间和并发症发生率等。结果肥胖组患者的PBV最高(P<0.05),肥胖组患者的总失血量和隐性失血量与超重组和正常组比较,差异有统计学意义(P<0.05),但3组间术中出血量、总失血量和PBV的比值、血红蛋白和血细胞比容变化量比较,差异均无统计学意义(P>0.05)。3组患者均没有异体输血、肺栓塞和切口深层感染,3组深静脉血栓、切口红肿渗出和恶心呕吐的发生率比较,差异无统计学意义(P>0.05)。结论在加速康复流程下,肥胖患者行TKA围术期失血风险更高,其中隐性失血是主要原因,但肥胖患者失血量和血容量的比值、异体输血率、血红蛋白和血细胞比容变化量并没有升高。

Objective To evaluate the influence of obesity on perioperative blood loss following enhanced recovery after primary total knee arthroplasty(TKA).Methods The patients undergoing primary TKA were divided into normal group(BMI:18.0 to 24.0 kg/m^2),overweight group(24.0 to 28.0 kg/m^2)and obese group(BMI≥28.0 kg/m^2)according to body mass index(BMI)from August 2017 to August 2018.We evaluated the baseline indicators,total blood loss(TBL),intraoperative blood loss,hidden blood loss(HBL),the ratio of TBL and patient’s blood volume(PBV),transfusion rate,hemoglobin and hematocrit drop,length of hospital and incidence of complications.Results The PBV was the most in obese patients(P<0.05).The TBL and HBL in obese group were higher than those in normal and overweight group(P<0.05).There was no significant difference in the intraoperative blood loss,ratio of total blood loss and PBV,hemoglobin or hematocrit drop among the three groups(P>0.05).No transfusion,pulmonary embolism and deep infection was emerged.The incidences of deep vein thrombosis,incision swelling and exudation,nausea and vomiting were similar(P>0.05).Conclusion Obese patients suffered from higher risk of perioperative blood loss,especially HBL following enhanced recovery after primary TKA.However,the ratio of TBL and PBV,allogeneic transfusion rate,the changes of hemoglobin and hematocrit are similar among the three groups.