综合止血措施下自体血回输装置对全膝关节置换术失血控制的有效性分析

doi:10.3969/j.issn.1671-167X.2018.04.014

摘要/Abstract

摘要： 目的：分析在围手术期综合性止血措施下，初次全膝关节置换术（total knee arthroplasty, TKA）使用自体血回输（autologous blood transfusion, ABT）装置引流和非负压引流球引流对于术后失血和输血控制的有效性。方法：回顾性收集2014年6月至2015年6月在北京大学第三医院诊断为重度骨性关节炎，并经同一手术医师完成的单侧、初次TKA患者共131例。按照临床中是否在术后使用ABT装置分为两组，其中ABT组于术后应用ABT装置进行引流和自体血回输，对照组于术后应用非负压引流球进行引流。比较两组患者术后的引流量、血红蛋白下降值、总失血量、隐性失血量及输血率的差异。结果：ABT组术后引流量显著高于对照组［515 mL (80~1 610 mL) vs. 260 mL (40~670 mL)，P<0.001］，ABT组术后自体血回输量的中位数为245 mL (60~1 070 mL)。两组患者在术后1 d血红蛋白下降值（P=0.340）、术后3 d血红蛋白下降值（P=0.524）、术后3 d的总失血量（P=0.101）和隐性失血量（P=0.062）上差异均无统计学意义。131例患者中共9例接受了异体输血（ABT组5/64，7.8%；对照组4/67，6.0%），两组患者的输血率差异无统计学意义（P=0.943）。结论：在围手术期综合性止血措施的常规应用下，ABT装置对于控制单侧、初次TKA患者术后失血的效果并不明显，也未能有效降低异体血输血率，然而却加大了术后引流量，增加了患者的住院费用，因此，在单侧、初次TKA术后并无必要常规应用ABT装置。

关键词: 关节成形术, 置换, 膝, 输血, 自体, 失血, 手术

Abstract: Objective： To analyze the conventional application of using comprehensive hemostatic methods during the perioperative period, and the effect of autologous blood transfusion (ABT) device compared with non-negative pressure drainage on preventing blood loss and allogenic blood transfusion after primary total knee arthroplasty (TKA). Methods: A total of 131 patients (131 knees) with severe knee osteoarthritis who underwent unilateral primary TKA by the same surgeon in Peking University Third Hospital from June 2014 to June 2015 were enrolled in this study. The patients were divided into ABT group (64 patients) and control group (67 patients). ABT devices were used for drainage and blood transfusion in the ABT group while the control group used the non-negative pressure drainage only. The results of the drainage fluid volume, the decrease of hemoglobin, the total blood loss, the hidden blood loss and blood transfusion after TKA were compared between the two groups. Results: The drainage fluid volume in ABT group was significantly higher than that in control group ［515 mL (80-1 610 mL) vs. 260 mL (40-670 mL), P<0.001］. The autologous blood transfusion in ABT group was 245 mL (60-1 070 mL). There were no significant differences between the two groups in the value of hemoglobin decrease 1 day after surgery (P=0.340) and 3 days after surgery (P=0.524). There were no significant differences in the total blood loss (P=0.101) and the hidden blood loss (P=0.062) between the two groups either. There were 9 patients in the 131 patients who received allogeneic blood transfusion, of whom 5 in the ABT group (5/64, the blood transfusion rate was 7.8%) and 4 in the control group (4/67, the blood transfusion rate was 6.0%), and no significant differences in the blood transfusion rate between the two groups (P=0.943). Conclusion: With the conventional application of using comprehensive hemostatic methods during perioperative period, the ABT device did not show the effective result of controlling postoperative blood loss and failed to reduce the rate of allogeneic blood transfusion in patients with unilateral primary TKA. However, the ABT device could increase the drainage fluid volume and improve the patient’s hospitalization expenses. Therefore, there is no need for routine application of ABT device in unilateral primary TKA.

Key words: Arthroplasty, replacement, knee, Blood transfusion, autologous, Blood loss, surgical

中图分类号:

李杨，李邦国，赵然，田华，张克. 综合止血措施下自体血回输装置对全膝关节置换术失血控制的有效性分析[J]. 北京大学学报(医学版), 2018, 50(4): 651-656.

LI Yang, LI Bang-guo, ZHAO Ran, TIAN Hua, ZHANG Ke. Effect of autologous blood transfusion device on preventing blood loss in primary total knee arthroplasty using comprehensive hemostatic methods[J]. Journal of Peking University(Health Sciences), 2018, 50(4): 651-656.

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