红细胞单采术在高原红细胞增多人群关节置换术中的应用

Application of Erythrocytapheresis in Patients with High Altitude Polycythemia Underwent Arthroplasty

目的探讨红细胞单采术在高原红细胞增多人群行关节置换术中应用的安全性及预防下肢深静脉血栓的有效性。方法回顾性分析2018年10月至2020年8月在我院骨科行全髋关节置换术(total hip arthroplasty,THA)、全膝关节置换术(total knee arthroplasty,TKA)的45例西藏藏族男性患者的病例资料,其中34例髋,11例膝;年龄31~73岁,平均(51.40±13.29)岁;身体质量指数(body mass index,BMI)21.79~33.79 kg/m2,平均(28.69±3.05)kg/m2;术前血红蛋白191.00~249.00 g/L,平均(215.10±17.92)g/L;术前治疗性红细胞单采指征为Hb>190 g/L。于红细胞单采前、单采后次日、术后第1天及第3天查血常规,观察红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)和红细胞压积(hematocrit,Hct)变化情况。于红细胞单采前、术后第1天查D-二聚体,观察D-二聚体变化情况。于所有患者的术前及术后第1、3、7、14、35天常规行双下肢静脉彩超检查,进行下肢深静脉血栓(deep vein thrombosis,DVT)筛查。结果血常规:RBC单采前为(5.89~8.70)×1012/L,平均为(6.85±0.95)×1012/L;单采后为(3.84~6.63)×1012/L,平均为(5.30±0.75)×1012/L;术后第1天为(3.21~6.18)×1012/L,平均为(4.76±0.89)×1012/L;术后第3天为(3.25~6.10)×1012/L,平均为(4.28±0.98)×1012/L。单采后、术后第1天、术后第3天与单采前比较,差异均有统计学意义(P<0.05)。Hb单采前为191.00~249.00 g/L,平均为(215.10±17.92)g/L;单采后为133.00~191.00 g/L,平均为(167.60±16.26)g/L;术后第1天为109.00~180.00 g/L,平均为(150.67±21.95)g/L;术后第3天为108.00~175.00 g/L,平均为(133.00±24.15)g/L。单采后、术后第1天、术后第3天与单采前比较,差异均有统计学意义(P<0.05)。Hct单采前为57.70%~72.80%,平均为(62.73±5.24)%;单采后为38.90%~57.30%,平均为(49.45±4.93)%;术后第1天为32.10%~52.70%,平均为(44.11±5.94)%;术后第3天为32.30%~50.20%,平均为(38.70±6.52)%。单采后、术后第1天、术后第3天与单采前比较,差异均有统计学意义(P<0.05)。D-二聚体:单采前为0.01~1.20 mg/L,平均为(0.28±0.45)mg/L;术后第1天为2.37~6.07 mg/L,平均(4.04±1.54)mg/L。手术前后比较差异有统计学意义(P<0.05)。DVT:1例THA术后第1天出现双侧胫后静脉及左侧腓静脉、小腿肌间静脉血栓。无肺栓塞、无输血病例。结论对于高原红细胞增多人群,红细胞单采术可有效降低关节置换围术期DVT的发生率,且安全可靠,具有较好的临床应用价值。

Objective To investigate the safety of erythrocytapheresis in patients with high altitude polycythemia undergoing arthroplasty and the effectiveness of reducing the incidence of lower extremity deep vein thrombosis(DVT).Methods A retrospective analysis was carried out focusing on the clinical data of 45 Tibetan male patients who underwent total hip arthroplasty(THA)and total knee arthroplasty(TKA)in the Department of Orthopaedics of our hospital from October 2018 to August 2020.Of the enrolled 45 patients,34 cases underwent THA and the other 11 cases were provided with TKA.The average age was(51.40±13.29)years old(ranging:31 to 73).The body mass index(BMI)was 21.79~33.79 kg/m2,with a mean BMI of(28.69±3.05)kg/m2;and the mean preoperative hemoglobin was(215.10±17.92)g/L,with a mean value of 191.00~249.00 g/L.In addition,the indication of preoperative therapeutic erythrocytapheresis was Hb>190g/L.Blood samples were taken for routine blood test prior to and on the second day of erythrocytapheresis,the first day and the third day after the operation to observe the changes of red blood cellcount(RBC),hemoglobin(Hb)and hematocrit(Hct).Meanwhile,D-Dimer was detected by blood sampling before erythrocytapheresis and the first day after operation to observe the change of D-Dimer.All patients were examined by color Doppler ultrasound of of veins of both lower extremities routinely for DVT screening before and 1,3,7,14,35 days after operation.Results Routine blood test:RBC was tested to be(5.89~8.70)×1012/L and(3.84~6.63)×1012/L before and after erythrocytapheresis,with a mean value of(6.85±0.95)×1012/L and(5.30±0.75)×1012/L,respectively;besides,it was(3.21~6.18)×1012/L and(3.25~6.10)×1012/L one day and three day after operation,with the mean value of(4.76±0.89)×1012/L and(4.28±0.98)×1012/L,respectively.There was statistical difference between the values after single-harvest,postoperative day 1,postoperative day 3 and before single-harvest(P<0.05).Hb was 191.00~249.00 g/L and 133.00~191.00 g/L before erythrocytapheresis and after erythrocytapheresis,with the mean Hb of(215.10±17.92)g/L and(167.60±16.26)g/L,respectively;in addition,it was 109.00~180.00 g/L and 108.00~175.00 g/L 1 day and 3 day after operation,with the mean Hb of(150.67±21.95)g/L and(133.00±24.15)g/L,respectively;and the difference was statistically significant between the values after single-harvest,postoperative day 1,postoperative day 3 and before single-harvest(P<0.05).Hct was detected to be 57.70%~72.80%and 38.90%~57.30%before erythrocytapheresis and after erythrocytapheresis,with a mean value of(62.73±5.24)%and(49.45±4.93)%,respectively;and it was 32.10%~52.70%and 32.30%~50.20%one day and three day after operation,with the mean value of(44.11±5.94)%and(38.70±6.52)%,respectively,with statistically significant difference between the values after single-harvest,postoperative day 1,postoperative day 3 and before single-harvest(P<0.05).2.D-Dimer was detected to be 0.01~1.20 mg/L and 2.37~6.07 mg/L before erythrocytapheresis and one day after operation,with the mean value of(0.28±0.45)mg/L and(4.04±1.54)mg/L,respectively;and the difference was statistically significant(P<0.05).3.In terms of DVT,one patient was found to have thrombosis of bilateral posterior tibial vein,left fibular vein and calf intermuscular vein on the first day after THA.In addition,there was no cases of pulmonary embolism and blood transfusion.Conclusion Erythrocytapheresis can be effective to reduce the incidence of DVT for the population with high altitude polycythemia in the perioperative period of arthroplasty.Besides,it is safe and reliable,exhibiting good clinical application value.