贮存式自体血联合补血药物在多节段腰椎管狭窄症手术治疗中的应用效果

Effect of preoperative autologous blood donation combined with blood tonic in the surgical treatment of multilevel lumbar spinal stenosis

目的探讨贮存式自体血联合补血药物在多节段腰椎管狭窄症(lumbar spinal stenosis,LSS)手术治疗中的应用效果。方法选取2020年8月至2021年11月北京大学第三医院骨科收治的行后入路腰椎融合手术治疗多节段LSS的患者184例。所有患者术中均采用回收式自体输血,静脉滴注氨甲环酸。其中98例术前未采集贮存式自体血的患者纳入A组,86例术前7~10 d采集贮存式自体血并补充补血药物(铁剂和促红细胞生成素)的患者纳入B组,比较两组的用血效果。结果两组患者性别、年龄、体质量、手术时间和住院时间比较,差异均无统计学意义(P>0.05),术前及术后3 d的WBC和PLT比较,差异均无统计学意义(P>0.05)。B组术前RBC、血细胞比容(hematocrit,HCT)和Hb显著低于A组[(4.3±0.5)×10^(12)/L比(4.6±0.4)×10^(12)/L,(40.4±4.5)%比(42.5±3.9)%,(132.4±16.0)g/L比(141.5±13.2)g/L],且B组术后3 d的HCT显著高于A组[(37.2±4.4)%比(34.7±4.0)%],差异均有统计学意义(P<0.05),但两组术后3d的RBC和Hb比较,差异均无统计学意义(P>0.05)。B组异体血输注量和输血相关费用低于A组[(0.7±1.0)U比(1.6±2.1)U,434(155,695)元比731(125,825)元],差异均有统计学意义(P<0.05),两组术中出血量、引流量和回收式自体血输注量比较,差异均无统计学意义(P>0.05)。两组凝血功能相关指标比较,差异无统计学意义(P>0.05);B组术后并发症总发生率明显低于A组(9.3%比23.5%),差异有统计学意义(P<0.05)。结论行后入路腰椎融合手术治疗LSS患者采用贮存式自体血联合补血药物的方案,可减少异体输血量和术后并发症发生率,且对患者术后血常规和凝血功能等相关指标无影响。

Objective To investigate the effect of preoperative autologous blood donation combined with blood tonic in the surgical treatment of multilevel lumbar spinal stenosis(LSS).Methods A total of 184 patients with multilevel LSS treated by posterior lumbar interbody fusion in Department of Orthopedics,Peking University Third Hospital from August 2020 to November 2021 were selected.All patients were treated with recycled autologous blood transfusion and intravenous infusion of tranexamic acid.Among them,98 patients who did not collect preoperative autologous blood donation before operation were included in group A,and 86 with preoperative autologous blood donation 7-10 days before operation and supplemented with blood tonic(iron and erythropoietin)were included in group B,and the blood use effect of the two groups was compared.Results There were no significant differences in gender,age,body weight,operation time and length of hospital stay between the two groups(P>0.05).There were no significant differences in WBC and PLT before and three days after operation(P>0.05).Preoperative RBC,hematocrit(HCT)and Hb in group B were significantly lower than those in group A[(4.3±0.5)×10^(12)/L vs.(4.6±0.4)×10^(12)/L,(40.4±4.5)%vs.(42.5±3.9)%,(132.4±16.0)g/L vs.(141.5±13.2)g/L],and the HCT of group B was significantly higher than that of group A three days after operation[(37.2±4.4)%vs.(34.7±4.0)%],the differences were statistically significant(P<0.05).However,there was no significant difference in RBC and Hb between the two groups three days after operation(P>0.05).The allogeneic blood infusion volume and transfusion related costs in group B were lower than those in group A[(0.7±1.0)U vs.(1.6±2.1)U,434(155,695)yuan vs.731(125,825)yuan],the differences were statistically significant(P<0.05).There were no significant differences in intraoperative blood loss,drainage volume and recovered autotransfusion volume between the two groups(P>0.05).There was no significant difference in coagulation function related indexes between the two groups(P>0.05).The total incidence of postoperative complications in group B was significantly lower than that in group A(9.3%vs.23.5%),the difference was statistically significant(P<0.05).Conclusions The combination of preoperative autologous blood donation and blood tonic drugs can reduce the amount of allotransfusion and the incidence of postoperative complications in patients with multistage LSS treated by posterior lumbar fusion surgery,and has no effect on postoperative blood routine and coagulation function.