髋关节翻修术中多模式血液管理的临床应用研究
|
摘要
目的研究在髋关节翻修术中应用中多模式血液管理的有效性和安全性。方法回顾性分析2015年1月—2017年7月安徽医科大学附属省立医院收治的27例全身麻醉下行首次人工髋关节翻修术患者,分为采用多模式血液管理的患者13例(实验组)和未采用多模式血液管理的患者14例(对照组)。分析两组术前一般资料差异,比较两组术前血红蛋白、手术时间、术中失血量、术后2 d血红蛋白、围手术期输血量、术后引流量、深静脉血栓形成、肺栓塞及其他术后并发症发生率。结果两组年龄、性别及体重指数等一般资料比较,差异无统计学意义(P>0.05);两组术前血红蛋白水平、手术时间及并发症发生率比较,差异无统计学意义(P>0.05);两组术中失血量、术后引流量、术后2 d血红蛋白及术后输血量比较,差异有统计学意义(P <0.05)。结论多模式血液管理可有效减少髋关节翻修术的术中出血量、术后引流量及术后输血量,在安全性方面未见不良反应。
Objective To study the efficacy and safety of multi-mode blood management in the primary revision hip arthroplasty. Methods Totally 27 patients underwent revision hip arthroplasty under general anesthesia from January 2015 to July 2017. 13 patients with multi-mode blood management were enrolled in the experimental group, and the other 14 patients without multi-mode blood management were enrolled in the control group. The differences of age, sex and body mass index were compared between the experimental group and the control group. The preoperative hemoglobin, operation time, intraoperative blood loss, hemoglobin 2 days after operation,perioperative blood transfusion, postoperative drainage volume and the incidence of deep venous thrombosis,pulmonary embolism and other postoperative complications were compared between the two groups. Results There was no significant difference in age, sex and body mass index between the experimental group and the control group(P > 0.05). There was no significant difference in preoperative hemoglobin, operative time or incidence of complications between the experimental group and the control group(P > 0.05). There were significant differences in intraoperative blood loss, postoperative drainage volume, hemoglobin 2 days after operation and postoperative blood transfusion between the experimental group and control group(P < 0.05). Conclusions Multimodal blood management can effectively reduce intraoperative blood loss, postoperative drainage, postoperative blood transfusion,and has no side effect in safety.
Objective To study the efficacy and safety of multi-mode blood management in the primary revision hip arthroplasty. Methods Totally 27 patients underwent revision hip arthroplasty under general anesthesia from January 2015 to July 2017. 13 patients with multi-mode blood management were enrolled in the experimental group, and the other 14 patients without multi-mode blood management were enrolled in the control group. The differences of age, sex and body mass index were compared between the experimental group and the control group. The preoperative hemoglobin, operation time, intraoperative blood loss, hemoglobin 2 days after operation,perioperative blood transfusion, postoperative drainage volume and the incidence of deep venous thrombosis,pulmonary embolism and other postoperative complications were compared between the two groups. Results There was no significant difference in age, sex and body mass index between the experimental group and the control group(P > 0.05). There was no significant difference in preoperative hemoglobin, operative time or incidence of complications between the experimental group and the control group(P > 0.05). There were significant differences in intraoperative blood loss, postoperative drainage volume, hemoglobin 2 days after operation and postoperative blood transfusion between the experimental group and control group(P < 0.05). Conclusions Multimodal blood management can effectively reduce intraoperative blood loss, postoperative drainage, postoperative blood transfusion,and has no side effect in safety.
引文
[1]ROSENCHER N,KERKKAMP H E,MACHERAS G,et al.Orthopedic surgery transfusion hemoglobin european overview(OSTHEO)study:blood management in elective knee and hip arthroplasty in Europe[J].Transfusion,2003,43(4):459-469.
[2]BRIDGENS J P,EVANS C R,DOBSON P M,et al.Intraoperative red blood-cell salvage in revision hip surgery.a case-matched study[J].J Bone Joint Surg Am,2007,89(2):270-275.
[3]LASOCKI S,KRAUSPE R,von HEYMANN C,et al.PREPARE:the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery:a multicentre,observational study[J].Eur J Anaesthesiol,2015,32(3):160-167.
[4]SMILOWITZ N R,OBERWEIS B S,NUKALA S,et al.Association between anemia,bleeding,and transfusion with longterm mortality following noncardiac surgery[J].Am J Med,2016,129(3):315-323.e312.
[5]CHEN A F,KLATT B A,YAZER M H,et al.Blood utilization after primary total joint arthroplasty in a large hospital network[J].Hss J,2013,9(2):123-128.
[6]VOCHTELOO A J,BORGER van der BURG B L,MERTENSB,et al.Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion:an analysis of 1262surgically treated patients[J].BMC Musculoskelet Disord,2011,12:262.
[7]KURTZ S,ONG K,LAU E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from 2005to 2030[J].J Bone Joint Surg Am,2007,89(4):780-785.
[8]LABEK G,THALER M,JANDA W,et al.Revision rates after total joint replacement:cumulative results from worldwide joint register datasets[J].J Bone Joint Surg Br,2011,93(3):293-297.
[9]HUANG G P,JIA X F,XIANG Z,et al.Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty:a comparative study and meta-analysis[J].Med Sci Monit,2016,22:797-802.
[10]SPAHN D R.Anemia and patient blood management in hip and knee surgery:a systematic review of the literature[J].Anesthesiology,2010,113(2):482-495.
[11]BEATTIE W S,KARKOUTI K,WIJEYSUNDERA D N,et al.Risk associated with preoperative anemia in noncardiac surgery:a single-center cohort study[J].Anesthesiology,2009,110(3):574-581.
[12]RASOULI M R,RESTREPO C,MALTENFORT M G,et al.Risk factors for surgical site infection following total joint arthroplasty[J].J Bone Joint Surg Am,2014,96(18):e158.
[13]FOSS N B,KRISTENSEN M T,KEHLET H.Anaemia impedes functional mobility after hip fracture surgery[J].Age Ageing,2008,37(2):173-178.
[14]CUENCA J,GARCIA-ERCE J A,MARTINEZ F,et al.Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement[J].Int J Surg,2007,5(2):89-94.
[15]DEUTSCH A,SPAULDING J,MARCUS R E.Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty[J].J Arthroplasty,2006,21(5):628-635.
[16]LAFFOSSE J M,MINVILLE V,CHIRON P,et al.Preoperative use of epoietin beta in total hip replacement:a prospective study[J].Arch Orthop Trauma Surg,2010,130(1):41-45.
[17]TOMECZKOWSKI J,STERN S,MULLER A,et al.Potential cost saving of epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects:a discreteevent simulation model[J].PLo S One,2013,8(9):e72949.
[18]SINCLAIR K C,CLARKE H D,NOBLE B N.Blood management in total knee arthroplasty:a comparison of techniques[J].Orthopedics,2009,32(1):19.
[19]HONG K H,PAN J K,YANG W Y,et al.Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty:a metaanalysis[J].BMC Musculoskelet Disord,2016,17:142.
[20]YUN S H,KIM J H,KIM H J.Comparison of the hemodynamic effects of nitroprusside and remifentanil for controlled hypotension during endoscopic sinus surgery[J].J Anesth,2015,29(1):35-39.
[21]MA J,HUANG Z,SHEN B,et al.Blood management of staged bilateral total knee arthroplasty in a single hospitalization period[J].J Orthop Surg Res,2014,9:116.
[22]FARROW L S,SMITH T O,ASHCROFT G P,et al.A systematic review of tranexamic acid in hip fracture surgery[J].Br J Clin Pharmacol,2016,82(6):1458-1470.
[23]XIE J,MA J,YAO H,et al.Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet:a randomized clinical trial[J].J Arthroplasty,2016,31(11):2458-2464.
[24]QUINN M,BOWE A,GALVIN R,et al.The use of postoperative suction drainage in total knee arthroplasty:a systematic review[J].Int Orthop,2015,39(4):653-658.
[2]BRIDGENS J P,EVANS C R,DOBSON P M,et al.Intraoperative red blood-cell salvage in revision hip surgery.a case-matched study[J].J Bone Joint Surg Am,2007,89(2):270-275.
[3]LASOCKI S,KRAUSPE R,von HEYMANN C,et al.PREPARE:the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery:a multicentre,observational study[J].Eur J Anaesthesiol,2015,32(3):160-167.
[4]SMILOWITZ N R,OBERWEIS B S,NUKALA S,et al.Association between anemia,bleeding,and transfusion with longterm mortality following noncardiac surgery[J].Am J Med,2016,129(3):315-323.e312.
[5]CHEN A F,KLATT B A,YAZER M H,et al.Blood utilization after primary total joint arthroplasty in a large hospital network[J].Hss J,2013,9(2):123-128.
[6]VOCHTELOO A J,BORGER van der BURG B L,MERTENSB,et al.Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion:an analysis of 1262surgically treated patients[J].BMC Musculoskelet Disord,2011,12:262.
[7]KURTZ S,ONG K,LAU E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from 2005to 2030[J].J Bone Joint Surg Am,2007,89(4):780-785.
[8]LABEK G,THALER M,JANDA W,et al.Revision rates after total joint replacement:cumulative results from worldwide joint register datasets[J].J Bone Joint Surg Br,2011,93(3):293-297.
[9]HUANG G P,JIA X F,XIANG Z,et al.Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty:a comparative study and meta-analysis[J].Med Sci Monit,2016,22:797-802.
[10]SPAHN D R.Anemia and patient blood management in hip and knee surgery:a systematic review of the literature[J].Anesthesiology,2010,113(2):482-495.
[11]BEATTIE W S,KARKOUTI K,WIJEYSUNDERA D N,et al.Risk associated with preoperative anemia in noncardiac surgery:a single-center cohort study[J].Anesthesiology,2009,110(3):574-581.
[12]RASOULI M R,RESTREPO C,MALTENFORT M G,et al.Risk factors for surgical site infection following total joint arthroplasty[J].J Bone Joint Surg Am,2014,96(18):e158.
[13]FOSS N B,KRISTENSEN M T,KEHLET H.Anaemia impedes functional mobility after hip fracture surgery[J].Age Ageing,2008,37(2):173-178.
[14]CUENCA J,GARCIA-ERCE J A,MARTINEZ F,et al.Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement[J].Int J Surg,2007,5(2):89-94.
[15]DEUTSCH A,SPAULDING J,MARCUS R E.Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty[J].J Arthroplasty,2006,21(5):628-635.
[16]LAFFOSSE J M,MINVILLE V,CHIRON P,et al.Preoperative use of epoietin beta in total hip replacement:a prospective study[J].Arch Orthop Trauma Surg,2010,130(1):41-45.
[17]TOMECZKOWSKI J,STERN S,MULLER A,et al.Potential cost saving of epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects:a discreteevent simulation model[J].PLo S One,2013,8(9):e72949.
[18]SINCLAIR K C,CLARKE H D,NOBLE B N.Blood management in total knee arthroplasty:a comparison of techniques[J].Orthopedics,2009,32(1):19.
[19]HONG K H,PAN J K,YANG W Y,et al.Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty:a metaanalysis[J].BMC Musculoskelet Disord,2016,17:142.
[20]YUN S H,KIM J H,KIM H J.Comparison of the hemodynamic effects of nitroprusside and remifentanil for controlled hypotension during endoscopic sinus surgery[J].J Anesth,2015,29(1):35-39.
[21]MA J,HUANG Z,SHEN B,et al.Blood management of staged bilateral total knee arthroplasty in a single hospitalization period[J].J Orthop Surg Res,2014,9:116.
[22]FARROW L S,SMITH T O,ASHCROFT G P,et al.A systematic review of tranexamic acid in hip fracture surgery[J].Br J Clin Pharmacol,2016,82(6):1458-1470.
[23]XIE J,MA J,YAO H,et al.Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet:a randomized clinical trial[J].J Arthroplasty,2016,31(11):2458-2464.
[24]QUINN M,BOWE A,GALVIN R,et al.The use of postoperative suction drainage in total knee arthroplasty:a systematic review[J].Int Orthop,2015,39(4):653-658.