两种血液保护技术在髋关节翻修术中的联合应用  

The combined application of two methods of blood conservation in hip arthroplasty

作　　者：薛彩霞 常世卿 莫基浩 

机构地区：[1]洛阳正骨医院输血科,河南洛阳471002

出　　处：《中国输血杂志》2014年第7期746-748,共3页Chinese Journal of Blood Transfusion

摘　　要：目的观察术中回收式自身输血（BS）控制性降压（CH）在髋关节翻修术患者术中联合应用的血液保护效果。方法选择2012年1月~2012年12月90名行髋关节翻修的患者随机分为3组,A组为对照组,B组为BS组,C组为BS联合CH组。观察记录各组患者术中的失血量、回收血量、输注异体血量、手术时间、术后引流量、有无输血不良反应及术前、术毕、术后2 d的血液动力学、血气、凝血功能、离子检测值。结果 C组患者出血量（1721.3±429.4）mL,输异体血量（393.3±213.2）mL,异体输血率80.0%,低于B组和A组P〈0.05。回收血量（802.7±205.8）mL。手术时间（148.9±46.1）min,与B组和A组相比较,P〈0.05。B、A组失血量、手术时间相比较无统计学意义,输异体血量相比较,P〈0.05。所有患者输血过程顺利,未出现输血不良反应。术后2 d各组患者的HR、CVP、PT、APTT、Plt、PaO2。SaO2、K、Na检测结果和术毕相比较,P〈0.05。和术前比较无差异。Hb、Hct、Plt检测值和术毕、术前比较,P〈0.05,但均在正常范围内。结论 BS联合CH组可以将术中的出血回收再利用,缩短手术时间,减少出血量,有减少或杜绝异体输血的效果,并且对患者的血液动力学稳定和凝血机制及离子水平无影响,这2种血液保护技术在髋关节翻修术中联合应用安全有效。Objective To study the blood conservation effect of combined application of blood salvage （BS） and controlled hypotension （CH） in hip arthroplasty. Methods 90 patients underwent hip athroplasty from Jan 2012 to Dec 2012 were divided randomly into 3 groups：group A （control） ,group B （BS） and group C （BS combined with CH ）. The bleeding volume, recovery volume, homologous blood transfusion volume, operation time, postoperative drainage volume and transfusion reaction of patients in each group were recorded. The hemadynamics indicators ,blood gas parameters ,blood coagulation function and blood ions levels were recorded before operation, fight after operation and 2 hours after operation. Results In group C, the bleeding volume was （ 1 721.3 ± 429.4 ） mL, homologous blood transfusion volume was （ 393.3 ± 213.2） mL, homologous blood transfusion rate was 80.0%, which were lower than that of group B and group A （P 〈 0. 05 ）. Recovery volume was （802.7 ± 205.8） mL and operation time was （148.9 ± 46.1 ）min in group C（ compared with that of group B and group A, P 〈 0. 05 ）. Between group B and group A, bleeding volume and operation time didn＇t have significant differences while homologous blood transfusion volume did（P 〈 0. 05 ）. No transfusion reaction occurred during the blood transfusion process in all patients. Compared the values of HR, CVP, PT, APTT, Ph, PaO2, SaO2 , K, Na 2 days after operations with the values acquired just after operations ,P 〈 0. 05. However,the values showed no differences when compared with preoperative levels. The values of Hb, Hct, Pit 2 days after operations were differnet with that of pre-operation and after-operation（ P 〈 0. 05 ）, but all the values were in the normal range. Conclusion In group C （ BS combined with CH） ,the lost blood could be recovered,the operation time and bleeding volume could be decreased. In conclusion,the method of BS combined with CH could reduce the homologous blood transfusion while had no

关 键 词：回收式自身输血 控制性降压 髋关节翻修术 

分 类 号：R457.1[医药卫生—治疗学]