全膝关节置换术的围术期异体输血分析及备血方案更新

Perioperative transfusion analysis and blood ordering schedule update for total knee arthroplasty

目的了解全膝关节置换术患者围术期异体红细胞输注率及其危险因素,并分析交叉配血-输血比(C∶T比)。方法本研究为回顾性队列研究。收集2014年1月~2019年10月在本医院行全膝关节置换术和翻修术的患者围术期资料。计算围术期异体红细胞输注率,采用二分类Logistic回归分析其危险因素。计算围术期C∶T比,根据手术类型和年龄等进行亚组分析。结果2903例患者纳入研究,其围术期异体红细胞输注率为10.9%(95%CI 9.8%~12.0%),C∶T比为5.6∶1,危险因素为年龄(OR=1.025,95%CI 1.009~1.042,P<0.01)、术前血红蛋白(OR=0.966,95%CI 0.954~0.978,P<0.001)、术前贫血(OR=3.543,95%CI 2.052~6.119,P<0.001)、血液系统疾病(OR=6.462,95%CI 2.479~16.841,P<0.001)、双侧手术(OR=7.681,95%CI 5.759~10.245,P<0.01)和翻修手术(OR=9.584,95%CI 4.360~21.065,P<0.001)。结论围术期年龄增加、术前低血红蛋白、术前贫血、合并血液系统疾病、双侧手术和翻修手术是全膝关节置换术围术期输血的独立危险因素。术前无贫血、无血液系统疾病、年龄<75岁的单侧手术患者可以仅完成分型筛选,术前贫血、有血液系统疾病、双侧和翻修手术,推荐至少交叉配血1~4 U。

Objective To investigate the perioperative rate of allogeneic red blood cell(RBC)transfusion in patients who underwent total knee arthroplasty(TKA)and its risk factors,and to identify its cross-match to transfusion ratio(C∶T ratio).Methods Anesthetic data of patients who underwent TKA from January 2014 to October 2019 in Peking Union Medical College Hospital were collected and analyzed retrospectively.Perioperative allogeneic RBC transfusion rate was calculated,and binary Logistic regression analysis was performed to identify its risk factors in these patients.The overall C∶T ratio was calculated and divided into subgroups based on surgery type and age group.Results The study enrolled 2903 patients.The perioperative rate of allogeneic RBC transfusion in TKA patients was 10.9%(95%CI 9.8%~12.0%)and overall C∶T ratio was 5.6∶1.The independent risk factors leading to perioperative allogeneic RBC transfusion included advanced age(OR=1.025,95%CI 1.009~1.042,P<0.01),preoperative hemoglobin level(OR=0.966,95%CI 0.954~0.978,P<0.001),preoperative anemia(OR=3.543,95%CI 2.052~6.119,P<0.001),hematological diseases(OR=6.462,95%CI 2.479~16.841,P<0.001),bilateral surgery(OR=7.681,95%CI 5.759~10.245,P<0.01)and revision surgery(OR=9.584,95%CI 4.360~21.065,P<0.001).Conclusion The risk factors for perioperative allogeneic RBC transfusion in TKA patients included advanced age,preoperative low hemoglobin level,preoperative anemia,hematological diseases,bilateral surgery and revision surgery.Only type and screen tests are recommended if patients receiving unilateral primary TKA surgery are less than 75 years old without anemia and hematological diseases,while at least one to four units of blood should be cross-matched if patients are with preoperative anemia and hematological diseases or will receive bilateral and revision arthroplasty.