围手术期全程血液管理在老年腰椎退行性疾病治疗中的应用  

Application of whole perioperative blood management for elderly lumbar degenerative disease

作　　者：席焱海[1] 薛敏涛[1] 余将明[1] 王伟恒[1] 温剑坤 叶晓健[1] XIYanhai;XUE Min tao;YU Jiangming;WANGWeiheng;WEN Jian kun;YE Xiaojian(Deparment of Spinal Surgery,Changzheng Hospital,Secondary Military M ed icalU niversity,Shanghai200003,China)

机构地区：[1]第二军医大学附属长征医院脊柱外科,上海200003

出　　处：《脊柱外科杂志》2018年第3期144-147,共4页Journal of Spinal Surgery

基　　金：中华国际医学交流基金会2016骨科围手术期血液管理研究项目(2016-N-14-06)

摘　　要：目的观察围手术期全程血液管理对老年腰椎退行性疾病患者术中出血量、术后引流量以及输血量的影响,探讨减少围手术期出血的有效方法。方法回顾性分析2014年1月—2016年12月收治的90例老年退行性腰椎疾病患者,早期45例患者采用围手术期常规血液管理模式(常规组),后期45例患者采用围手术期全程血管理模式(全程组)。记录并比较2组患者手术时间、术中出血量、术后引流量、输血例数及输血量、血红蛋白浓度和红细胞压积。结果全程组手术时间、术中出血量、术后引流量、输血例数、输血量均低于常规组,术后3 d及1周血红蛋白浓度、红细胞压积均高于常规组,差异均具有统计学意义(P<0.05)。结论老年腰椎退行性疾病患者采用围手术期全程血液管理可有效降低术中出血量和术后引流量,降低输血量和输血率,有利于患者术后恢复。Objective To observe the effect of whole perioperative blood management on intraoperative blood loss, postoperative drainage volume and blood transfusion volume in elderly patients with lumbar degenerative diseases, and explore the effective methods for reducing perioperative bleeding. Methods From January 2014 and December 2014, the data of 90 elderly patients with lumbar degenerative diseases were analyzed retrospectively. In the early 45 cases, the routine blood management model was used in the perioperative period（routine group）, and 45 patients in the later period adopted the whole perioperative blood management（whole period group）. The operative time, intraoperative blood loss, postoperative drainage volume, number of blood transfusion cases, blood transfusion volume, hemoglobin concentration and hematocrit were recorded and compared between the 2 groups. Results The operative time, intraoperative blood loss, postoperative drainage volume, blood transfusion volume and blood transfusion volume in the whole period group were lower than those in the routine group; hemoglobin concentration and hematocrit at 3 d and 1 week after operation were higher than those in routine group; the differences were statistically significant（P〈0.05）. Conclusion The whole perioperative blood management in the patients with lumbar degenerative diseases can effectively reduce the intraoperative blood loss and postoperative drainage volume, and reduce the amount of blood transfusion and the rate of blood transfusion, which is beneficial to the recovery of the patients after operation.

关 键 词：腰椎 椎间盘退行性变 失血 手术 输血 自体 围手术期医护 老年人 

分 类 号：R681.533[医药卫生—骨科学]