全膝关节置换术中脉冲冲洗结合术后自体血回输的应用研究  

Application of pulse joint autologous transfusion in total knee arthroplasty

作　　者：周智[1] 熊亚琼 谢跃[1] 王黎明[2] 

机构地区：[1]南京医科大学附属淮安第一医院骨科,江苏淮安223300 [2]南京医科大学附属南京医院骨科

出　　处：《中国输血杂志》2015年第10期1229-1231,共3页Chinese Journal of Blood Transfusion

基　　金：国家自然科学基金项目支持(项目批准号81171745)

摘　　要：目的在全膝关节置换中应用术中脉冲冲洗联合术后自体血回输与单用术后自体血回输进行比较,分析对膝关节置换手术失血、凝血、炎症、血栓指标的影响。方法选取因膝关节骨性关节炎行单侧人工全膝关节置换术患者96例,随机分成实验组(术中脉冲冲洗联合术后自体血回输)和对照组(单用术后自体血回输),比较两组患者一般资料,总引流量及术前术后静脉血血红蛋白值,以及行异体血输血情况,检测对比不同时点两组的PT、APTT、TNF-α、IL-6、D-D值,并术后行下肢血管彩超检查。结果 2组患者一般资料,总引流量及术前术后静脉血血红蛋白值,行异体血输血情况和术后的PT、APTT值比较比较,差异无统计学意义(P>0.05)。实验组术后d1、d7的TNF-α、IL-6值,术后d4的D-D异常率以及下肢DVT的发生率均低于对照组,差异有统计学意义(P<0.05)。结论全膝关节置换术中脉冲冲洗联合术后自体血回输,且较单用自体血回输未增加出血,对凝血功能无影响,可以减轻炎症、减少深静脉血栓的发生,可以减少手术的并发症,值得临床推广。Objective To explore the effect of pulse irrigation combined with autologous transfusion on the markers such as loss of blood, blood coagulation, inflammation and thrombus in patients undergoing total knee arthroplasty, and to compare the effect of autologous transfusion on the control. Methods 96 patients who underwent unilateral total knee arthro- plasty due to knee osteoarthritis were randomly divided into experimental group （pulse irrigation combined with autologous transfusion after surgery） and control group （autologons transfusion only after surgery）. The general information, overall drainage, preoperative and postoperative hemoglobin values, and allogeneic blood transfusion were compared in two groups. The markers, such as PT, APTY, TNF-α, IL-6, D-D of two groups, were also compared at different time points. All pa- tients underwent lower extremity vascular ultrasound examination after operation. Results There were no significant difference found in patients＇ general information, overall drainage, preoperative and postoperative hemoglobin values, allogeneic blood transfusion and postoperative PT and APTY of two groups （ P 〉 0. 05）. The TNF-ct and IL-6 values on 1 and 7 days after operation, the abnormal rate of DDs 4 days after operation, the incidence of DVT in the experimental group were significantly lower than those in the control group （ P 〈 0. 05 ）. Conclusion Pulse irrigation combined with postoperative autologous blood transfusion in total knee arthroplasty did not increase bleeding, had no effect on blood coagulation, and can reduce inflammation and the incidence of deep vein thrombosis than the usage of autologous blood transfusion alone. Thus, this method can reduce surgical complications and would be worthy of clinical promotion.

关 键 词：全膝关节置换 脉冲 自体血液回输 肿瘤坏死因子-α 白介素-6 D-二聚体 

分 类 号：R687.4[医药卫生—骨科学] R457.1[医药卫生—外科学]