不同输血策略对老年全髋关节置换术患者预后的影响
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摘要
目的探讨不同输血策略对老年全髋关节置换术患者预后的影响。方法回顾性分析2013年10月至2018年11月于解放军总医院海南医院首次行择期全髋关节置换术、年龄大于65岁的259例患者的临床资料,其中21例输血后无疗效评价,未纳入统计分析。根据患者术后血红蛋白水平分别将其分为限制性输血组(当Hb≤80 g/L时进行红细胞输注,并将Hb维持在80～100 g/L之间) 100例,开放性输血组(Hb≤100 g/L时进行红细胞输注,并维持Hb在100 g/L以上) 138例。记录并比较两组患者的输血及血红蛋白变化情况[红细胞输注总量、术前Hb值,术后(输血前) Hb值、离院前(输血后) Hb值],以及两组患者的术后并发症发生率及住院时间。结果两组患者的性别、年龄、体重、麻醉ASA分级,心肺疾病分布及术前Hb等一般资料比较差异均无统计学意义(P>0.05);开放性输血组患者的平均输血量为(3.8±1.0) U,小于限制性输血组的(4.0±3.2) U,开放性输血组离院前(输血后) Hb为(114±9) g/L,明显大于限制性输血组的(90±6) g/L,差异均有统计学意义(P<0.05);两种输血策略中患者30 d死亡例数均为0,故两种输血策略对患者30 d死亡率无影响;开放性输血组与限制性输血组肺炎发生率分别为0.7%、7.0%,伤口感染发生率分别为0.7%、6.0%,心衰的发生率分别为0、6.0%,差异均有统计学意义(P<0.05);开放性输血组患者的平均住院时间为(10±3) d,明显短于限制性输血组的(14±7) d,差异有统计学意义(P<0.05)。结论对老年全髋关节置换患者实行开放性输血策略有助于减少术后并发症的产生,降低住院时长,有利于改善患者预后。
Objective To investigate the effect of different transfusion strategies on the prognosis of elderly patients undergoing total hip arthroplasty. Methods The clinical data of 259 patients(more than 65 years old) who underwent total hip arthroplasty at Hainan Hospital of Chinese PLA General Hospital from October 2013 to November 2018 were retrospectively analyzed, of which 21 patients had no efficacy evaluation after transfusion and thus were excluded in the statistical analysis. According to the postoperative hemoglobin level, the patients were divided into restricted blood transfusion group(100 cases, infuse red blood cell when Hb≤80 g/L and maintain Hb in the range of 80 g/L to 100 g/L) and open transfusion group(138 cases, infuse red blood cell when Hb≤100 g/L and maintain Hb more than 100 g/L). The transfusion and hemoglobin changes(total red blood cell transfusion, preoperative Hb value, postoperative[before transfusion] Hb value, pre-departure [post-transfusion] Hb value), and incidence of postoperative complications and length of hospital stay were recorded and compared between the two groups. Results There were no significant differences in gender, age, body weight, anesthesia ASA grade, cardiopulmonary disease distribution, and preoperative Hb between the two groups(P>0.05). The average blood transfusion volume, pre-departure(post-transfusion) Hb value of the open transfusion group was(3.8±1.0) U,(114±9) g/L in the open transfusion group, which were significantly different from(4.0±3.2) U,(90±6) g/L in the restricted transfusion group(P<0.05). The number of 30-day deaths in the two transfusion strategies was both 0, which indicates that the two strategies had no effect on the 30-day mortality of the patients. The two groups shwoed statistically significant difference in incidence of pneumonia(0.7% vs 7.0%), wound infection(0.7% vs 6.0%), and heart failure(0 vs 6.0%), P<0.05. The average length of hospital stay in the open blood transfusion group was(10±3) days, which was significantly shorter than(14±7) days of the restrictive transfusion group(P<0.05). Conclusion The open transfusion strategy for elderly patients undergoing total hip arthroplasty can reduce the incidence of postoperative complications, reduce the length of hospital stay, and help improve the prognosis of patients.
Objective To investigate the effect of different transfusion strategies on the prognosis of elderly patients undergoing total hip arthroplasty. Methods The clinical data of 259 patients(more than 65 years old) who underwent total hip arthroplasty at Hainan Hospital of Chinese PLA General Hospital from October 2013 to November 2018 were retrospectively analyzed, of which 21 patients had no efficacy evaluation after transfusion and thus were excluded in the statistical analysis. According to the postoperative hemoglobin level, the patients were divided into restricted blood transfusion group(100 cases, infuse red blood cell when Hb≤80 g/L and maintain Hb in the range of 80 g/L to 100 g/L) and open transfusion group(138 cases, infuse red blood cell when Hb≤100 g/L and maintain Hb more than 100 g/L). The transfusion and hemoglobin changes(total red blood cell transfusion, preoperative Hb value, postoperative[before transfusion] Hb value, pre-departure [post-transfusion] Hb value), and incidence of postoperative complications and length of hospital stay were recorded and compared between the two groups. Results There were no significant differences in gender, age, body weight, anesthesia ASA grade, cardiopulmonary disease distribution, and preoperative Hb between the two groups(P>0.05). The average blood transfusion volume, pre-departure(post-transfusion) Hb value of the open transfusion group was(3.8±1.0) U,(114±9) g/L in the open transfusion group, which were significantly different from(4.0±3.2) U,(90±6) g/L in the restricted transfusion group(P<0.05). The number of 30-day deaths in the two transfusion strategies was both 0, which indicates that the two strategies had no effect on the 30-day mortality of the patients. The two groups shwoed statistically significant difference in incidence of pneumonia(0.7% vs 7.0%), wound infection(0.7% vs 6.0%), and heart failure(0 vs 6.0%), P<0.05. The average length of hospital stay in the open blood transfusion group was(10±3) days, which was significantly shorter than(14±7) days of the restrictive transfusion group(P<0.05). Conclusion The open transfusion strategy for elderly patients undergoing total hip arthroplasty can reduce the incidence of postoperative complications, reduce the length of hospital stay, and help improve the prognosis of patients.
引文
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[8] SEHAT KR, EVANS R, NEWMAN JH. How much blood is reallylost in total knee arthroplasty? Correct blood loss management should take hidden loss into account[J]. Knee, 2000, 7(3):151-155.
[9]魏均强,陶笙,白林,等.髋关节置换术者对失血和输血量的影响[J].华南国防医学杂志, 2015, 29(5):367-369, 384.
[10] FOWLER AJ, AHMAD T, PHULL MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery[J]. Br J Surg, 2015, 102(11):1314-1324.
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[12] ZHOU Q, ZHOU Y, WU H, et al. Changes of hemoglobin and hematocrit in elderly patients receiving lower joint arthroplasty without allogeneic blood transfusion[J]. Chin Med J(Engl), 2015, 128(1):75-78.
[13] SPAHN DR. Anemia and patient blood management in hip and knee surgery:A systematic review of the literature[J]. Anesthesiology,2010, 113:482-495.
[14] ABDUL-AZIZ B, LORENCATTO F, STANWORTH SJ, et al. Patients'and health care professionals'perceptions of blood transfusion:a systematic review[J]. Transfusion, 2018, 58(2):446-455.
[15]卫生部.临床输血技术规范[S].卫医发[2000]184号.
[16] CONLON NP, BALE EP, HErbison GP, et al. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65years old[J]. Anesth Analg, 2008, 106(4):1056-1061.
[17]邓秋萍,肖可明,郑宇浩,等.老年髋部骨折患者术后输血策略比较[J].临床输血与检验, 2019, 21(2):143-145.
[18]卢才义,王士雯,赵玉生,等.肺部感染与老年多器官功能衰竭的研究[J].中国实用内科杂志, 2006, 26(4):259-261.
[19] LAWRENCE VA, SILVERSTEIN JH, CORNELL JE, et al. Higher Hb level is associated with better early functional recovery after hip fracture repair[J]. Transfusion, 2003, 43(12):1717-1722.
[2] CHEN AF, KLATT BA, YAZER MH, et al. Blood utilization after primary total joint arthroplasty in a large hospital network[J]. HSS J,2013, 9(2):123-128.
[3] PANG WW, SCHRIER SL. Anemia in the elderly[J]. Curr Opin Hematol, 2012, 19(3):133-140.
[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] SPINELLI E, BARTLETT RH. Anemia and transfusion in critical care:Physiology and management[J]. J Intensive Care Med, 2016, 31(5):295-306.
[6]李永旺,陈芳,王冬婷,等.急性高容量血液稀释用于老年髋关节置换术的可行性研究[J].重庆医学, 2010, 39(23):3175-3177.
[7]王士雯.老年多器官功能不全综合征的肺启动机制[J].中华老年多器官疾病杂志, 2002, 5(1):4-6.
[8] SEHAT KR, EVANS R, NEWMAN JH. How much blood is reallylost in total knee arthroplasty? Correct blood loss management should take hidden loss into account[J]. Knee, 2000, 7(3):151-155.
[9]魏均强,陶笙,白林,等.髋关节置换术者对失血和输血量的影响[J].华南国防医学杂志, 2015, 29(5):367-369, 384.
[10] FOWLER AJ, AHMAD T, PHULL MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery[J]. Br J Surg, 2015, 102(11):1314-1324.
[11] LIU X, ZHANG X, CHEN Y, et al. Hidden blood loss after total hip arthroplasty[J]. The Journal of Arthroplasty, 2011, 26(7):1100-1105.
[12] ZHOU Q, ZHOU Y, WU H, et al. Changes of hemoglobin and hematocrit in elderly patients receiving lower joint arthroplasty without allogeneic blood transfusion[J]. Chin Med J(Engl), 2015, 128(1):75-78.
[13] SPAHN DR. Anemia and patient blood management in hip and knee surgery:A systematic review of the literature[J]. Anesthesiology,2010, 113:482-495.
[14] ABDUL-AZIZ B, LORENCATTO F, STANWORTH SJ, et al. Patients'and health care professionals'perceptions of blood transfusion:a systematic review[J]. Transfusion, 2018, 58(2):446-455.
[15]卫生部.临床输血技术规范[S].卫医发[2000]184号.
[16] CONLON NP, BALE EP, HErbison GP, et al. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65years old[J]. Anesth Analg, 2008, 106(4):1056-1061.
[17]邓秋萍,肖可明,郑宇浩,等.老年髋部骨折患者术后输血策略比较[J].临床输血与检验, 2019, 21(2):143-145.
[18]卢才义,王士雯,赵玉生,等.肺部感染与老年多器官功能衰竭的研究[J].中国实用内科杂志, 2006, 26(4):259-261.
[19] LAWRENCE VA, SILVERSTEIN JH, CORNELL JE, et al. Higher Hb level is associated with better early functional recovery after hip fracture repair[J]. Transfusion, 2003, 43(12):1717-1722.