多模式血液管理策略在初次单侧膝、髋关节置换术中的临床应用  

Multimodal blood management strategy in primary unilateral total knee or hip arthroplasty

作　　者：关健[1] 曹晓瑞[1] 王刚[1] 康飞科[1] 朱锦宇[1] 韩一生[1] 朱庆生[1] Guan Jian Cao Xiaorui Wang Gang Kang Feike Zhu Jinyu Han Yisheng Zhu Qingsheng(Department of Orthopedics, Xijing Hospital, the Fourth Military Medical University, Xi＇an 710032, China)

机构地区：[1]第四军医大学西京医院关节外科,西安710032

出　　处：《中华解剖与临床杂志》2017年第2期116-120,共5页Chinese Journal of Anatomy and Clinics

基　　金：国家卫生计生委公益性行业科研专项项目（20132007）

摘　　要：目的 评估多模式血液管理策略在初次单侧膝、髋关节置换术（TKA/THA）围手术期应用对减少患者围手术期输血率的有效性及安全性 .方法 纳入2015年11月-2016年10月在第四军医大学西京医院关节外科行初次单侧TKA/THA,应用多模式血液管理策略的403例患者资料为观察组（TKA 285例、THA 118例）进行前瞻性研究;收集2014年6月-2015年10月行初次单侧TKA/THA的582例患者资料为对照组（TKA 393例、THA 189例）进行对照研究,两组患者年龄、性别、BMI、术前血常规检验结果等比较,差异均无统计学意义（P值均〉0.05）.两组患者均接受TKA或THA,术中均取1 g氨甲环酸行关节内注射;观察组患者另在围术期行多模式血液管理.比较两组患者围手术期输血率、Hb最大下降值、手术失血量、引流量,以及深静脉血栓、肺栓塞及其他严重术后并发症发生率.结果 术后观察组与对照组输血率分别为1.2%（5/403）和8.2%（48/582）,两组中TKA患者输血率分别为0.7%（2/285）和6.9%（27/393）、THA患者输血率分别为2.5%（3/118）和11.8%（21/189）,差异均有统计学意义（χ^2=22.962、15.353、7.402, P值均〈0.01）.TKA术后观察组与对照组患者Hb最大下降值分别为（29.62±11.36）g/L和（34.37±12.88）g/L,THA患者分别为（33.29±11.56）g/L和（37.14±9.42）g/L,两组间比较差异均有统计学意义（t＇=5.078、3.042, P值均〈0.01）;两组TKA患者手术失血量分别为（91.35±58.79） mL和（157.90±71.35） mL,THA患者手术失血量分别为（172.42±65.64） mL和 （246.12±87.89） mL,差异均有统计学意义（t′=13.271、8.378, P值均〈0.01）.深静脉血栓发生率观察组为0.74%（3/403）、对照组为0.85%（5/582）,差异无统计学意义（χ^2=0.039, P〉0.05）.结论 摇采用多模式血液管理策略可明显降低初次膝、髋置换患者的术后异体输血率,提高患者术后血红蛋白水平,并且不会增加术后并发Objective To evaluate the efficacy and safety of multimodal blood management strategy in blood transfusion during perioperative period of primary unilateral total knee arthroplasty （TKA） and total hip arthroplasty （THA）.Methods Prospectively recruited 403 patients （285 of whom underwent TKA and 118 of whom underwent THA） were admitted to the Department of Joint Surgery of Xijing Hospital between November 2015 and October 2016 as the study group, while records of 582 patients （393 of whom underwent TKA and 189 of whom underwent THA） between June 2014 and October 2015 were also investigated as the controls.Two groups were basically well-matched on separate index in baseline characteristics （all P values〉0.05）.Tranexamic acid was used in all patients, and perioperative multimodal blood management was implemented in the study group.Blood transfusion rate, maximum decline of hemoglobin, intraoperative blood loss, drainage volumes and the incidence of deep vein thrombosis, pulmonary thromboembolism and other postoperative complication were assessed.Results Blood transfusion rate of study group and controls were 1.2% （5/403） and 8.2% （48/582）.Specifically, blood transfusion rate in patients undergoing TKA was 0.7% （2/285） and 6.9% （27/393） in the study group and controls, while patients underwent THA was 2.5% （3/118） and 11.8% （21/189） in both group （χ^2=22.962, 15.353 and 7.402, all P values〈0.01）.Maximizing hemoglobin was （29.62±11.36） g/L for study group and （34.37±12.88） g/L for controls in TKA patients, and as for THA patients, this parameter was （33.29±11.56） g/L and （37.14±9.42） g/L （t′=5.078 and 3.042, all P values〈0.01）.Moreover, intraoperative blood loss was （91.35±58.79） mL and （157.90±71.35） mL for study and control group in TKA patients, while （172.42±65.64） mL and （246.12±87.89） mL in THA patients, respectively （t′=13.271 and 8.378, all P〈0.01）.There was an insignificant trend toward incidence of de

关 键 词：关节成形术 置换 膝 关节成形术 置换 髋 人工关节 血液管理 输血 

分 类 号：R687.4[医药卫生—骨科学]