多模式血液管理在全髋关节置换术中的临床效果1998例回顾分析  

Clinical effects of different blood management strategies in total hip arthroplasty: a report of 1998 cases

作　　者：曹国瑞[1] 黄强[1] 雷一霆 张少云[1] 徐彬 裴福兴[1] CAO Guo-rui;HUANG Qiang;LEI Yi-ting;ZHANG Shao-yun;XU Bin;PEI Fu-xing(West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]浙江省立同德医院骨科,杭州310012

出　　处：《中国骨与关节杂志》2017年第12期889-893,共5页Chinese Journal of Bone and Joint

基　　金：2013年度卫生行业科研专项项目(201302007)

摘　　要：目的评价促红细胞生成素(erythropoietin,EPO)和铁剂以及静脉多次应用氨甲环酸(tranexamic acid,TXA)在全髋关节置换术(total hip arthroplasty,THA)中的临床效果,能否进一步降低围术期失血量和异体输血率。方法回顾性分析于2014年5月至2017年1月,在我中心行初次单侧THA的患者1998例,根据相关血液管理策略分为A组、B组和C组,静脉单次应用TXA的患者分为A组,在此基础上应用EPO和铁剂的患者分为B组,在此基础上静脉多次TXA的患者分为C组,比较三组患者的围术期失血量、异体输血率、血红蛋白和血细胞比容下降水平。结果围术期失血量A组(1102.0±503.7)ml,B组(937.0±441.9)ml,C组(774.5±380.6)ml;异体输血率A组7.3%,B组4.1%、C组1.6%;术后第1天血红蛋白A组(23.8±12.4)g/L,B组(18.3±10.8)g/L,C组(16.1±10.3)g/L;术后第1天血细胞比容A组(0.068±0.038),B组(0.056±0.036),C组(0.048±0.036);术后第3天血红蛋白A组(12.1±16.3)g/L,B组(10.1±8.3)g/L,C组(7.5±9.2)g/L;术后第3天血细胞比容A组(0.033±0.027),B组(0.030±0.025),C组(0.026±0.019),差异有统计学意义(P=0.002)。C组的围术期失血量、异体输血率、血红蛋白和血细胞比容下降水平均少于A和B组,三组的异体输血率依次为7.3%,4.1%和1.6%,差异有统计学意义(P<0.001)。结论应用EPO和铁剂联合可显著减少THA围术期失血量和异体失血率,联合静脉多次应用TXA效果更优。Objective To evaluate the clinical effects of erythropoietin, iron and multiple boluses of intravenous tranexamic acid （ IV-TXA ） in patients following primary total hip arthroplasty （ THA ）. Methods A large, single-center, retrospective study was done in 1998 patients who underwent primary THA from May 2014 to January 2017. Group A received 20 mg / kg IV-TXA 5 - 10 minutes before skin incision. Group B received erythropoietin and iron supplement on the basis of Group A. Group C received 20 mg / kg IV-TXA before skin incision and 1 g IV-TXA 3, 6, 12, 24 hours later on the basis of Group B. Total blood loss, allogenic transfusion rate, hemoglobin and hematocrit drop were compared. Results Comparing Group A, B, C, there were statistical differences in total blood loss （ 1102.0 ± 503.7 ） vs （ 937.0 ± 441.9 ） vs （ 774.5 ± 380.6 ） ml, allogenic transfusion rate （ 7.3% vs 4.1% vs 1.6% ）, hemoglobin （ 23.8 ± 12.4 ） vs （ 18.3 ± 10.8 ） vs （ 16.1 ± 10.3 ） g / L and hematocrit （ 0.068 ± 0.038 ） vs （ 0.056 ± 0.036 ） vs （ 0.048 ± 0.036 ） drop on postoperative day 1, hemoglobin （ 12.1 ± 16.3 ） vs （ 10.1 ± 8.3 ） vs （ 7.5 ± 9.2 ） g / L and hematocrit （ 0.033 ± 0.027 ） vs （ 0.030 ± 0.025 ） vs （ 0.026 ± 0.019 ） drop on postoperative day 3 among the three groups （ P = 0.002 ）. The total blood loss, transfusion rate, hemoglobin and hematocrit drop of Group C were lower than those of Group A, B. The transfusion rate was 7.3%, 4.1% and 1.6% in Group A, B and C. The difference was significant （ P 〈 0.001 ）. Conclusions Application of erythropoietin and iron can reduce blood loss and allogenic transfusion rate in patients following THA. Patients can gain a smaller decline of Hb and blood loss combining with multiple boluses of IV-TXA.

关 键 词：关节成形术 置换 髋 氨甲环酸 输血 血液管理 

分 类 号：R687.4[医药卫生—骨科学]