医源性抽血对全膝关节置换术围术期失血的影响
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摘要
[目的]评价医源性抽血对初次单侧全膝关节置换术(total knee arthroplasty, TKA)围术期贫血的影响。[方法]回顾性分析2017年8月～2018年1月于四川大学华西医院关节外科行初次单侧TKA的患者141例。依据围术期常规检验抽血量,抽血在17管(约51 ml)的患者66例,列为常规组;抽血在30管(约90 ml)的患者75例,列为额外组。评价两组患者围术期的总失血量和术后血红蛋白变化量。[结果]两组患者的基线指标差异无统计学意义(P>0.05),常规组与额外组在总失血量(659.53±429.50 ml vs 610.48±516.71 ml, P=0.329)的差异无统计学意义;两组术后第1、3 d,血红蛋白均显著下降(P<0.05),但均未达到中度贫血诊断标准,且于术后15 d恢复至接近术前水平,各时间点两组间血红蛋白的差异均无统计学意义(P>0.05)。两组患者围手术期间均没有需要输血的病例。[结论]在血液管理策略干预下,大量的医源性抽血(30管,约90 ml)并不会增加TKA患者围术期的失血量和贫血发生率。
[Objective] To evaluate the effect iatrogenic blood drawing on perioperative blood loss in primary total knee arthroplasty(TKA). [Methods] A retrospective, controlled study was performed on 141 patients who underwent TKA in our department from August 2017 to January 2018. Based on the blood volume drawn for laboratory tests, 66 patients who received routine tests with 17 tubes of blood sample about 51 ml were enrolled as the routine group, while 75 patients who had extra laboratory tests with 30 tubes of blood sample about 90 ml were the extra group. The total blood loss and hemoglobin(Hb) variation were compared between the two groups. [Results] No a significant difference in the demographic data was found between the two groups(P>0.05). There was no a statistical differences in the total blood loss between them [(659.53±429.50) m L vs(610.48±516.71] mL, P=0.329). Although the Hb significantly dropped at 1 and 3 days after operation in both group(P<0.05), which not met the moderate anemia criteria and almost returned to preoperative level at 15 days postoperatively, no significant difference in Hb was noticed at any corresponding times points between the two groups(P>0.05). No any patient in both groups had allogenetic transfusion amid perioperative period. [Conclusion] With the application of modern blood management, including tranexamic acid, intraoperative controlled hypotension, erythropoietin and iron supplement, more iatrogenic blood drawing with30 tubes and about 90 mL of blood does not increase perioperative blood loss and incidence of anemia in TKA.
[Objective] To evaluate the effect iatrogenic blood drawing on perioperative blood loss in primary total knee arthroplasty(TKA). [Methods] A retrospective, controlled study was performed on 141 patients who underwent TKA in our department from August 2017 to January 2018. Based on the blood volume drawn for laboratory tests, 66 patients who received routine tests with 17 tubes of blood sample about 51 ml were enrolled as the routine group, while 75 patients who had extra laboratory tests with 30 tubes of blood sample about 90 ml were the extra group. The total blood loss and hemoglobin(Hb) variation were compared between the two groups. [Results] No a significant difference in the demographic data was found between the two groups(P>0.05). There was no a statistical differences in the total blood loss between them [(659.53±429.50) m L vs(610.48±516.71] mL, P=0.329). Although the Hb significantly dropped at 1 and 3 days after operation in both group(P<0.05), which not met the moderate anemia criteria and almost returned to preoperative level at 15 days postoperatively, no significant difference in Hb was noticed at any corresponding times points between the two groups(P>0.05). No any patient in both groups had allogenetic transfusion amid perioperative period. [Conclusion] With the application of modern blood management, including tranexamic acid, intraoperative controlled hypotension, erythropoietin and iron supplement, more iatrogenic blood drawing with30 tubes and about 90 mL of blood does not increase perioperative blood loss and incidence of anemia in TKA.
引文
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[6]周宗科,翁习生,孙天胜,等.中国骨科手术加速康复--围术期血液管理专家共识[J].中华骨与关节外科杂志,2017,10(1):1-7.
[7]Spahn DR.Anemia and patient blood management in hip and knee surgery:a systematic review of the literature[J].Anesthesiology,2010,113(2):482-495.
[8]王兰香,李巨奇,陈尔真,等.EICU患者医源性贫血与检验失血量的相关性研究[J].中国急救医学,2013(8):719-722.
[9]刘俊,黎远清,陈泽宇.医源性抽血对ICU患者血红蛋白的影响[J].吉林医学,2013(14):2723-2724.
[10]Lei Y,Xie J,Xu B,et al.The efficacy and safety of multiple-dose intravenous tranexamic acid on blood loss following total knee arthroplasty:a randomized controlled trial[J].Int Orthop,2017,41(10):2053-2059.
[11]雷一霆,黄强,曹国瑞,等.促红细胞生成素联合应用铁剂和氨甲环酸对减少全膝关节置换术围术期失血效果的研究[J].中国骨与关节杂志,2017(12):894-898.
[12]Dale JC,Ruby SG.Specimen collection volumes for laboratory tests[J].Arch Pathol Lab Med,2003,127(2):162-168.
[13]姜东辉万献尧.ICU患者检验性失血与疾病预后的相关性研究[D].中华医学会第二届全国重症医学大会论文集,成都,2007:287-291.2018-06-27
[2]Singh JA.Epidemiology of knee and hip arthroplasty:a systematic review[J].Open Orthop J,2011,5(1):80-85.
[3]Beattie WS,Karkouti K,Wijeysundera DN,et al.Risk associated with preoperative anemia in noncardiac surgery:a single-center cohort study[J].Anesthesiology,2009,110(3):574-581.
[4]Musallam KM,Tamim HM,Richards T,et al.Preoperative anaemia and postoperative outcomes in non-cardiac surgery:a retrospective cohort study[J].Lancet,2011,378(9800):1396-1407.
[5]周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复--围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.
[6]周宗科,翁习生,孙天胜,等.中国骨科手术加速康复--围术期血液管理专家共识[J].中华骨与关节外科杂志,2017,10(1):1-7.
[7]Spahn DR.Anemia and patient blood management in hip and knee surgery:a systematic review of the literature[J].Anesthesiology,2010,113(2):482-495.
[8]王兰香,李巨奇,陈尔真,等.EICU患者医源性贫血与检验失血量的相关性研究[J].中国急救医学,2013(8):719-722.
[9]刘俊,黎远清,陈泽宇.医源性抽血对ICU患者血红蛋白的影响[J].吉林医学,2013(14):2723-2724.
[10]Lei Y,Xie J,Xu B,et al.The efficacy and safety of multiple-dose intravenous tranexamic acid on blood loss following total knee arthroplasty:a randomized controlled trial[J].Int Orthop,2017,41(10):2053-2059.
[11]雷一霆,黄强,曹国瑞,等.促红细胞生成素联合应用铁剂和氨甲环酸对减少全膝关节置换术围术期失血效果的研究[J].中国骨与关节杂志,2017(12):894-898.
[12]Dale JC,Ruby SG.Specimen collection volumes for laboratory tests[J].Arch Pathol Lab Med,2003,127(2):162-168.
[13]姜东辉万献尧.ICU患者检验性失血与疾病预后的相关性研究[D].中华医学会第二届全国重症医学大会论文集,成都,2007:287-291.2018-06-27