接受全膝关节置换术患者围手术期输血的影响因素分析  

Analysis of factors influencing perioperative blood transfusion in patients undergoing total knee arthroplasty

作　　者：阮潜瑛 张彬 易中梅 宋娜丽 吴春曦 Ruan Qianying;Zhang Bin;Yi Zhongmei;Song Nali;Wu Chunxi(Department of Blood Transfusion,First Hospital Affiliated to Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院输血科,重庆400038

出　　处：《国际输血及血液学杂志》2023年第4期346-351,共6页International Journal of Blood Transfusion and Hematology

摘　　要：目的探讨接受全膝关节置换术(TKA)患者围手术期输血的影响因素。方法选择2015年1月至2022年11月于陆军军医大学第一附属医院接受TKA治疗的全部211例膝骨关节炎或膝类风湿关节炎患者为研究对象。患者中位年龄为65岁(61,72岁);男性患者为45例,女性为166例;围手术期输血患者为101例,未接受输血治疗者为110例。收集患者的临床病例资料,如性别、年龄、术前血红蛋白(pHb)、术前活化部分凝血活酶时间(pAPTT)、术前凝血酶原时间(pPT)等,分析其对患者围手术期输血的影响。对影响患者TKA围手术期输血临床资料的单因素分析,根据资料类型采用Wilcoxon秩和检验、χ^(2)检验或连续性校正χ^(2)检验;多因素分析采用非条件logistic回归分析。本研究遵循的程序符合陆军军医大学第一附属医院人体试验委员会制定的标准,经过该伦理委员会批准[批准文号:(B)KY202252],并与所有受试者签署临床研究知情同意书。结果①单因素分析结果显示,患者性别、pHb值、术后引流量及是否合并高血压可能是患者TKA围手术期输血的影响因素(χ^(2)=6.44,P=0.011;χ^(2)=44.54,P<0.001;χ^(2)=23.74,P<0.001;χ^(2)=4.22,P=0.040)。101例围手术期输血患者中,以女性(86.1%,87/101),pHb值<120 g/L(65.3%,66/101),术后引流量>200 mL(56.4%,57/101),以及未合并高血压(78.2%,79/101)患者为主。②多因素非条件logistic回归分析结果显示,pHb值<120 g/L(RR=11.366,95%CI:5.433~23.779,P<0.001),pPT≤11 s(RR=2.330,95%CI:1.167~4.652,P=0.016),术后引流量>200 mL(RR=6.066,95%CI:2.951~12.470,P<0.001)均为接受TKA患者围手术期输血的独立危险因素。结论纠正术前贫血,限制术后引流,通过补充血容量预防患者血液处于高凝状态,可能是降低膝骨关节炎或膝类风湿关节炎患者TKA围手术期输血风险的有效途径。ObjectiveTo investigate influencing factors of perioperative blood transfusion in patients underwent total knee arthroplasty(TKA).MethodsFrom January 2015 to November 2022,a total of 211 patients with knee osteoarthritis or knee rheumatoid arthritis who underwent TKA treatment in the First Hospital Affiliated to Army Medical University were selected as research subjects.The median age of these patients was 65 years(61,72 years),with 45 male and 166 female patients.There were 101 patients who received perioperative blood transfusion and 110 patients who did not.Patients′clinical data,such as gender,age,preoperative hemoglobin(pHb),preoperative activated partial thromboplastin time(pAPTT),and preoperative prothrombin time(pPT),etc.,were collected and analyzed for their impact on perioperative blood transfusion in patients.For univariate factor analysis of clinical data affecting perioperative blood transfusion in patients underwent TKA,Wilcoxon rank sum test,chi-square test or correction for continuity chi-square test was used according to the type of data;and multivariate analysis used unconditional logistic regression analysis.The procedures followed in this study were in accordance with the standards established by the Medical Ethics Committee of the First Affiliated Hospital of the Army Military Medical University[Approval No.(B)KY202252],and all the subjects signed the informed consents for clinical trials.Results①Results of univariate analysis showed that gender,pHb value,postoperative drainage volume,and whether combined with hypertension may be influencing factors of perioperative blood transfusion in patients underwent TKA(χ^(2)=6.44,P=0.011;χ^(2)=44.54,P<0.001;χ^(2)=23.74,P<0.001;χ^(2)=4.22,P=0.040).Among the 101 patients who received perioperative blood transfusion,the majority were females(86.1%,87/101),pHb level<120 g/L(65.3%,66/101),postoperative drainage volume>200 mL(56.4%,57/101),and without hypertension(78.2%,79/101).②Results of multivariate unconditional logistic regression analysis sho

关 键 词：关节成形术 置换 膝 骨关节炎 膝 输血 贫血 术后引流 

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