腰椎后路手术应用不同输血方式对出血量及引流量的影响  

Effects of different transfusion on intraoperative blood loss and postoperative drainage volume in posterior lumbar spinal surgery

作　　者：邹海波[1] 绳厚福[1] 李中实[1] 郝庆英[1] 赵景鑫[1] 陈栋[1] 王思[2] 冉强[1] 

机构地区：[1]中日友好医院骨科-脊柱外科,北京100029 [2]中日友好医院手术麻醉科,北京100029

出　　处：《中华医学杂志》2014年第5期338-343,共6页National Medical Journal of China

摘　　要：目的 探讨腰椎后路手术应用不同输血方式对出血量及引流量的影响.方法 2010年6月至2012年1月北京中日友好医院脊柱外科共有183例因腰椎疾病行初次手术的患者,男74例,女109例,年龄31～81岁,平均56.6岁.其中腰椎间盘突出症80例,腰椎管狭窄症69例,腰椎滑脱症32例,腰椎间盘源性疼痛2例.单节段手术共83例,双节段手术共100例.术中无输血34例,自体血回输109例,输注同种异体血20例,自体血和同种异体血混合输入20例.所有病例均记录手术时间、手术节段、术中输注自体血量、术中输注同种异体血量、术中出血量、术后即刻的引流量、引流管体内放置的时间及最终引流量.结果 单节段手术患者术中出血量是（369.4±284.0） ml,而双节段手术患者的术中出血量是（568.8±398.7） ml,二者差异有统计学意义（t=3.94,P〈0.001）.单节段手术患者的最终引流量是（186.3±135.6） ml,而双节段手术患者的最终引流量是（301.4±286.8） ml,二者差异有统计学意义（t=3.56,P〈0.05）.术中单独应用自体血液回输,对术中出血量的影响与无输血的患者差异有统计学意义（P〈0.001）,术中单独应用自体血液回输,与其他输血方式相比对术中出血量的影响差异无统计学意义（P＆gt;0.05）.术中单独应用自体血液回输,与其他方式比较,对术后返回病房即刻引流量和术后最终引流量无影响（P＆gt;0.05）.不同手术节段,对选择术中自体血液回输有倾向性,双节段手术的患者选择自体血液回输更多;而不同手术节段,对术中输注异体血无明显的倾向性.≥60岁与〈60岁的患者,在术中出血量和引流量上无明显差别.引流管体内放置的时间与术后最终引流量之间呈正相关关系（Spearman′s r=0.320,P〈0.001）,而术后返回病房即刻引流管的状态（夹闭或开放）与术后引流量之间的差异无统计学意义（P＆gt;0.05）.结论 术中单独应Objective To explore the effects of autotransfusion on intraoperative blood loss and postoperative drainage volume in posterior lumbar spinal surgery. Methods From June 2010 to January 2012, a total of 183 patients with lumbar disease were enrolled. There were 74 males and 109 females with an average age of 56.6 （ 31--81 ） years. There were lumbar disc herniation （ n = 80 ） , lumbar stenosis （ n = 69）, lumbar spondylolisthesis （ n = 32） and discogenie pain （ n = 2）. And one-level （ n = 83 ） and two-level （n = 100） operations were performed. The treatments were non-transfusion （n = 34）, autoblood （n = 109） and allogeneie blood （ n = 20 ） and both （ n = 20 ） . Operative duration, operative level, intraoperative autologous blood transfusion, intraoperative allogeneic blood transfusion, intraoperative blood loss, immediate drainage volume, duration of drainage tube and final drainage volume were recorded. Results The mean intraoperative blood loss was （ 369.4 ± 284.0 ） ml and （ 568.8 ± 398.7 ） ml for two-level operation, there were singifieant differences between them（ t = 3.94, P 〈 0. 001 ）. The final drainage volume was （ 186. 3 ± 135.6） ml for one-level patients and （ 301.4±286. 8 ） ml for two-level patients, there were singificant differences between them （t = 3.56, P 〈 0. 05 ）. The total instraoperative blood loss was （478. 3 ± 364. 3 ） ml and total final drainage volume was （249. 2 ± 237.4 ） ml, there were singificant differences between them （P 〈0. 001）. There were significant differences in blood loss between autologous blood transfusion for non-transfusion groups （ P 〈 0. 001 ）. However, there was no differencefor immediate draniage and final drainage comparing with orther blood transfusion methods （ P 〉 0. 05 ） . Conclusion Using autologous blood transfusion alone during operation has significant difference for inoperative blood loss compared with non-transfusion. Yet there is no effect on immediate or fi

关 键 词：外科手术 腰椎 输血 自体 出血 引流 

分 类 号：R687.3[医药卫生—骨科学]