老年人工全髋关节置换术与全膝关节置换术后隐性失血的相关机制及输血策略

发布时间：2018-05-15 19:36

本文选题：隐性失血 + 全髋关节置换术　；参考：《中国老年学杂志》2017年08期

【摘要】：目的探讨人工全髋关节置换术(THA)、人工全膝关节置换术(TKA)后老年患者隐性失血的相关机制及输血策略。方法首诊、单侧髋(膝)关节置换老年患者182例,术后1 d内补液量低于2 000 ml;86例实施THA,96例实施TKA,依据术前体质量进行Gross方程计算围术期失血量,重点观察显性与隐性失血情况,探讨隐性失血机制,制定相应的输血策略。结果 (1)围术期实际失血总量,THA组(1 462.5±215.6)ml,TKA组(1 455.8±241.8)ml;(2)隐性失血量,THA组(482.3±42.7)ml,TKA组(732.5±152.3)ml;(3)隐性失血占实际失血总比,THA组占31.5%,THA组占51.2%,两组隐性失血情况差异有统计学意义(P0.05);(4)TKA组采取引流血液回输处理患者25例隐性失血占实际失血总比47.6%,TKA组内未采取引流血液回输处理的71例隐性失血占实际失血总比58.3%,引流血液回输处理患者与未采取引流血液回输处理患者在实际的红细胞丢失量差异有统计学意义(P0.05),二者间隐性失血量差异无统计学意义,证实引流血液回输处理对隐性失血影响较低;组间不同情况下血红蛋白(Hb)指标波动无统计学差异(P0.05);(5)同组内肥胖病患与非肥胖病患隐性失血量并无明显差异(P0.05)。结论 TKA患者在围术期隐性失血率较高于THA,因此在TKA或THA术中需及时对骨质残留物进行全面细致清除,密切监测患者Hb变化;制定相应的输血策略,保证充足的血液预存准备,确保患者血循环恢复,减少贫血风险。
[Abstract]:Objective to investigate the mechanism and transfusion strategy of recessive blood loss in elderly patients after total hip arthroplasty (THAA) and total knee arthroplasty (TKA). Methods one hundred and eighty-two elderly patients with unilateral hip (knee) arthroplasty were treated with TKA for the first time. 86 patients with THAA were treated with THAKA within 1 day after operation. The perioperative blood loss was calculated by Gross equation according to the preoperative body mass. The dominant and recessive haemorrhage were observed, the mechanism of recessive blood loss was discussed, and the corresponding transfusion strategy was worked out. Results 1) the total amount of actual blood loss during perioperative period was 1 462.5 卤215.6ml TKA (1 455.8 卤241.8ml) recessive blood loss was 482.3 卤42.7ml TKA (732.5 卤152.3 卤152.3 ml) recessive blood loss accounted for 51.2% in tha group. There was significant difference in recessive blood loss between the two groups (P 0.05TKA group). In TKA group, 71 cases of recessive blood loss accounted for 58.3% of actual blood loss, while those of patients treated with drainage and those without drainage were 58.3%. The difference of RBC loss between the two groups was statistically significant (P 0.05), but there was no significant difference between the two groups in recessive blood loss. The results showed that the effect of drainage blood transfusion on recessive blood loss was low, and there was no significant difference in the fluctuation of hemoglobin HB between groups (P 0.05). There was no significant difference in hidden blood loss between obese patients and non-obese patients in the same group (P 0.05). Conclusion the recessive blood loss rate in patients with TKA during perioperative period is higher than that in THAs. Therefore, it is necessary to remove bone residues thoroughly and carefully in time during TKA or THA operation, closely monitor HB changes in patients, formulate corresponding transfusion strategies, and ensure adequate preparation for blood storage. Ensure the recovery of blood circulation and reduce the risk of anemia.
【作者单位】：贵州省骨科医院;
【分类号】：R687.4

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