膝关节置换术围术期失血影响因素分析

Influencing factors of perioperative blood loss in knee arthroplasty

目的探讨膝关节置换术围术期失血的影响因素。方法行膝关节置换术的198例患者,结合实际情况,调查影响围术期失血的相关因素,主要包括年龄、性别、体质量指数(BMI)、手术时间、止血带压力、使用抗凝药物、自体血回输及假体类型等。结果男性围术期总失血量(1923.23±212.31)ml多于女性的(1224.34±227.24)ml,年龄>60岁患者围术期总失血量(1784.23±221.55)ml多于≤60岁的(1422.23±123.55)ml,BMI>27 kg/m^(2)的患者围术期总失血量(1756.67±189.23)ml多于BMI为23~27 kg/m^(2)的(1545.66±173.45)ml和BMI<23 kg/m^(2)的(1342.78±132.52)ml,手术时间≥80 min患者围术期总失血量(1821.62±156.22)ml多于手术时间<80 min的(1422.50±134.54)ml,止血带压力300 mm Hg(1 mm Hg=0.133 kPa)患者围术期总失血量(1678.22±178.22)ml多于止血带压力280 mm Hg患者的(1478.78±158.23)ml和260 mm Hg患者的(1203.23±156.45)ml,未使用抗凝药物患者围术期总失血量(1526.23±156.67)ml多于使用的(1223.34±167.24)ml,有自体血回输患者的围术期总失血量(3212.23±782.67)ml多于无自体血回输的(2034.34±410.23)ml,假体类型为髁间开放式患者的围术期总失血量(2530.34±302.23)ml多于髁间闭合式的(2056.23±246.75)ml,差异均具有统计学意义(P<0.05)。结论实施膝关节置换术患者围术期失血与多种因素有关,如年龄、性别、BMI、手术时间、止血带压力、是否使用抗凝药物、是否自体血回输及假体使用类型等,因此对于高龄、男性及肥胖患者,需要提高警惕,采取全程出血管理,严控控制手术时间及止血带压力,及时采用抗凝药物,尽可能选择髁间闭合式假体,减少围术期失血量。

Objective To discuss the influencing factors of perioperative blood loss in knee arthroplasty.Methods There were 198 patients undergoing knee arthroplasty.Based on the actual situation,the related factors that affect perioperative blood loss,including age,gender,body mass index(BMI),operation time,tourniquet pressure,use of anticoagulants,autologous blood transfusion,and type of prosthesis.Results The total blood loss(1923.23±212.31)ml during the perioperative period in men was more than(1224.34±227.24)ml of women;the total perioperative blood loss(1784.23±221.55)ml of patients>60 years old was more than(1422.23±123.55)ml of patients≤60 years old;the total perioperative blood loss of patients with BMI>27 kg/m^(2)[(1756.67±189.23)ml]was more than that of patients with BMI 23-27 kg/m^(2)[(1545.66±173.45)ml]and BMI<23 kg/m^(2)[(1342.78±132.52)ml];the total perioperative blood loss(1821.62±156.22)ml of patients with operation time≥80 min was more than(1422.50±134.54)ml of patients with operation time<80 min;the total perioperative blood loss(1678.22±178.22)ml of patients with tourniquet pressure of 300 mm Hg(1 mm Hg=0.133 kPa)was more than(1478.78±158.23)ml of patients with tourniquet pressure of 280 mm Hg and 260 mm Hg(1203.23±156.45)ml;the total perioperative blood loss(1526.23±156.67)ml of patients without anticoagulants was more than(1223.34±167.24)ml of patients with anticoagulants;the total perioperative blood loss(3212.23±782.67)ml of patients with autologous blood transfusion was more than(2034.34±410.23)ml of patients without autologous blood transfusion;the total perioperative blood loss(2530.34±302.23)ml of patients with open intercondylar type was more than(2056.23±246.75)ml of patients with closed intercondylar type.All the difference was statistically significant(P<0.05).Conclusion There are many factors related to perioperative blood loss,such as age,gender,BMI,operation time,tourniquet pressure,use of anticoagulants,autologous blood transfusion and prosthesis type for patients undergoing knee arthroplasty.Therefore,for elderly men and obese patients,it is necessary to be vigilant,adopt full bleeding management,strictly control operation time and tourniquet pressure,timely use anticoagulants,and choose intercondylar closed prosthesis as much as possible to reduce perioperative blood loss.