人工关节置换术围术期血液管理策略研究  

Research of the Blood Management Strategy in the Perioperative Period of Arthroplasty

作　　者：曾昭勇[1] 魏鲁青[1] 张健平[1] 

机构地区：[1]广东省佛山市第一人民医院骨科,广东佛山528000

出　　处：《实用骨科杂志》2016年第3期209-212,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨人工关节置换术患者围手术期的血液管理方法。方法收集2010年7月至2015年7月期间我院接受人工关节置换治疗患者132例,随机分成四组:实验组32例采用自体血回收(preoperative autologous blood donation,PAD)联合急性等容血液稀释(acute normovolemic hemodihtion,ANH),对照一组30例单纯采用PAD,对照二组40例单纯采用ANH,对照三组30例仅予以术后封闭式负压引流(closed suction drainage,CSD),对比四组的术后失血量以及异体血输注量等。结果实验组及对照一组术后1 d时红细胞计数(red blood cell count,RBC)、血红蛋白(hemoglobin,Hb)及红细胞压积(hematocrit,HCT)无明显变化(P>0.05),而对照二组及对照三组显著降低(P<0.05);四组术后住院时间比较差异无统计学意义(P>0.05),但实验组的贫血率及并发症总发生率均显著低于各对照组(P<0.05);实验组的急性失血量以及异体血输注量显著低于对照组(P<0.05)。结论 PAD联合ANH应用于人工关节置换术围手术期血液管理有利于减少术后异体血输注量以及术后急性失血量,维持患者的生命体征平稳,值得在临床中推广应用。Objective To investigate the blood management strategy methods in the perioperative period of arthroplasty.Methods From July 2010 to July 2015,132 cases of patients underwent arthroplasty in our hospital were randomly divided into four groups： the experimental group（ 32 cases） received preoperative autologous blood donation（ PAD） combined with acute normovolemic hemodihtion（ ANH）,control group one（ 30 cases） received simple adoption PAD,40 cases in the control group two only received ANH,30 cases in the control group three only received closed suction drainage（ CSD）,the postoperative blood loss and allogeneic blood infusion amount of the four groups were compared. Results 1 d after surgery,the RBC,Hb and HCT of the experimental group and control group had no significant change（ P 〉0. 05）,while the control group two and control group three were significantly lower（ P 〈0. 05）; The hospital stay times of the four groups were not significantly different（ P 〉0. 05）,but the anemia and the total complication rate of experimental group were significantly lower than those in the control group（ P 〈0. 05）; acute blood loss and allogeneic blood transfusions in the experimental group was significantly lower than the control group（ P 〈0. 05）. Conclusion PAD and ANH applied in joint arthroplasty perioperative blood management helps to reduce the amount of postoperative allogeneic blood transfusion and acute blood loss after surgery,and the patient＇s vital signs remain stable.The method is worthy of promotion in clinical applications.

关 键 词：血液管理 人工关节置换术 术前自体血回收 急性等溶血稀释 封闭负压引流 

分 类 号：R687.42[医药卫生—骨科学]