自体血回输在腰椎后入路减压植骨融合内固定术中的应用和护理  

Application of autologous blood transfusion in patients undergoing posterior lumbar decompression and interbody fusion with internal fixation surgery and nursing such patients

作　　者：陈姝妤 凌玲 张玙 CHEN Shuyu;LINGg Ling;ZHANG Yu(Operating Room,Xuancheng People′s Hospital,Xuancheng 242000,Anhui,China)

机构地区：[1]宣城市人民医院手术室,安徽宣城242000 [2]皖南医学院第一附属医院弋矶山医院脊柱外科,安徽芜湖241001

出　　处：《皖南医学院学报》2024年第5期495-498,共4页Journal of Wannan Medical College

基　　金：安徽省脊柱畸形临床医学研究中心“医疗创新基金”(AHJZJX-GG2022-002)。

摘　　要：目的:探讨自体血回输在腰椎后入路减压植骨融合内固定术中的应用及其护理要点。方法:选取2021年7月~2022年12月在宣城市人民医院接受腰椎后入路减压植骨融合内固定术的60例患者作为研究对象,随机分为观察组和对照组各30例,均采取综合护理干预措施,观察组使用血液回收机回输自体血,对血容量纠正不足的病例,术中追加少量异体血;对照组按传统异体血输入。比较两组患者手术前后血红蛋白水平、红细胞计数、红细胞压积、凝血时间、术中出血量、异体血输血量、补液量与输血反应。结果:观察组患者异体输血量及补液量均少于对照组(P<0.001)。两组患者输血后红细胞压积、血红蛋白水平、红细胞计数均较输血前下降(P<0.01),但两组患者输血前后凝血时间变化差异均无统计学意义(P>0.05)。观察组未见输血不良反应,输血并发症发生率低于对照组(χ^(2)=4.630,P=0.031)。结论:腰椎后入路减压植骨融合内固定术术中会引起大量失血,通过自体血回输进行干预,可减少对异体血及补液量的需求,减少输血反应的发生,能达到满意的治疗效果。Objective:To investigate application of autologous blood transfusion in patients undergoing posterior lumbar decompression and interbody fusion with internal fixation surgery,and analyze the nursing points in such patients.Methods:Sixty patients undergoing posterior lumbar decompression and interbody fusion with internal fixation surgery in Xuancheng People′s Hospital were included from July 2021 to December 2022,and randomized to observational group and control group(n=30 for each group).Both groups received comprehensive nursing interventions.Patients in the observational group were treated with autologous blood transfusion via blood recovery machine,and the patients with insufficiently corrected blood volume during the operation were managed with small amount of allogeneic blood.Those in the control group just underwent traditional allogeneic blood transfusion.The two groups were compared concerning the hemoglobin level,red blood cell count,hematocrit,coagulation time,intraoperative blood loss,allogeneic blood transfusion volume,fluid rehydration and transfusion reaction before and after operation.Results:The amount of allogeneic blood transfusion and fluid rehydration in the observational group was lower than that in the control group(P<0.001).After blood transfusion,the hematocrit,hemoglobin level and red blood cell count in both groups were decreased compared to pre-transfusion(P<0.01),yet there was no significant difference in the change in coagulation time before and after transfusion in both groups(P>0.05).No adverse reaction to blood transfusion was observed in the observational group,and the incidence of complications from blood transfusion was lower in the observational group than in the control group(χ^(2)=4.630,P=0.031).Conclusion:Posterior lumbar decompression and interbody fusion with internal fixation surgery can cause significant blood loss.However,intervention of this condition through autologous blood transfusion can significantly reduce the need for allogeneic blood and fluid rehydration a

关 键 词：腰椎退行性疾病 腰椎后入路减压 椎间融合 内固定术 自体血回输 护理 

分 类 号：R473.6[医药卫生—护理学]