自体血回输在后路腰椎经椎间孔椎间融合术中的应用
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- 论文作者：陈文俊 ; 吕锦瑜 ; 李志伟 ; 刘军
- 年：2016
- 作者机构：江苏省中医院骨伤科;
- 论文关键词：腰椎经椎间孔椎间融合术 ; 自体血回输 ; 输血并发症
- 会议召开时间：2016-11-25
- 会议录名称：湖南中医药大学学报2016/专集：国际数字医学会数字中医药分会成立大会暨首届数字中医药学术交流会论文集
- 语种：中文
- 分类号：R687.3
- 学会代码：HNZY
- 会议名称：国际数字医学会数字中医药分会成立大会暨首届数字中医药学术交流会
- 会议地点：中国广东珠海
- 主办单位：国际数字医学会、Digital Chinese Medicine
- 学会名称：湖南中医药大学期刊杂志社
- 页数：1
- 文件大小：2017k
- 原文格式：D
- 会议级别：全国
摘要
目的:探讨自体血回输在后路腰椎经椎间孔椎间融合术(TLIF)手术中的应用及相关并发症情况。方法:选入从2009年1月1日起行TLIF手术的患者,术前常规准备术中自体血回输装置,术中根据出血量选用自体血回输,部分加输异体血浆和红细胞,统计患者术前术后血红蛋白值,术中出血量,术后引流量,拔管时间,输血相关并发症情况。结果:至2010年12月31日共行213例TLIF手术,其中单纯应用术中自体血回输45例,加输异体血25例,单纯应用自体血回输组平均年龄52岁,男17例,女28例,行单节段TLIF 40例,多节段TLIF 5例,术前平均血红蛋白值124g/L,术后第三天平均血红蛋白值116g/L,术中平均出血量380ml,术中自体血回输量320ml,术后引流量108ml,无输血相关并发症。加输异体血组平均年龄58岁,男8例,女17例,行单节段PLIF 2例,多节段TLIF 23例,术前平均血红蛋白值122g/L,术后第三天平均血红蛋白值109g/L,术中平均出血量800ml,术中自体血回输量450ml,平均补充输冰冻灭活血浆120ml、悬浮少白细胞红细胞1.5u,术后引流量178ml,3例出现发热,无其它输血相关并发症。结论:PLIF手术有一定出血量,适合应用术中自体血回输,可减少或避免输入异体血,降低相关并发症发生率。
Methods A consecutive series of patients undergone TLIF surgery from Jan. 1, 2009 to Dec. 31, 2010. Cell salvage was collected using Cell Saver system. Patients undergone autologouscell transfusion(ACT) were divided into two groups according to the intraoperative blood loss(Group A ≤ 500 ml, ACT; Group B ﹥ 500 ml, ACT and additional allogeneic blood). Peri-operative clinicaldata were determined, which included pre- and post-operative hemoglobin(Hb) value, intraoperative blood loss, drain output, transfusion-related complications.Results A total of 213 consecutivepatients undergone TLIF surgery. 45 patients underwent only autologous cell transfusion, and 25 patients underwent both ACT and additional allogeneic blood transfusion. In group A, the average age atthe time of operation was 52 years. There were 17 male patients and 28 females. 40 patients underwent two level fusion, and 5 patients underwent multilevel fusion. The Hb value was 124g/L preoperativeand 116g/L postoperative. The average intraoperative blood loss was 380 ml. The volume of intraoperative ACT was 320 ml. Drain output was 108 ml. There were no transfusion-related complications. Ingroup B, the average age at the time of operation was 58 years. There were 8 male patients and 17 females. 2 patients underwent two level fusion, and 23 patients underwent multilevel fusion. The Hb valuewas 122g/L preoperative and 109g/L postoperative. The average intraoperative blood loss was 800 ml. The volume of intraoperative ACT was 450 ml. Drain output was 178 ml. 3 patients suffered fever afterallogeneic blood transfusion.
Methods A consecutive series of patients undergone TLIF surgery from Jan. 1, 2009 to Dec. 31, 2010. Cell salvage was collected using Cell Saver system. Patients undergone autologouscell transfusion(ACT) were divided into two groups according to the intraoperative blood loss(Group A ≤ 500 ml, ACT; Group B ﹥ 500 ml, ACT and additional allogeneic blood). Peri-operative clinicaldata were determined, which included pre- and post-operative hemoglobin(Hb) value, intraoperative blood loss, drain output, transfusion-related complications.Results A total of 213 consecutivepatients undergone TLIF surgery. 45 patients underwent only autologous cell transfusion, and 25 patients underwent both ACT and additional allogeneic blood transfusion. In group A, the average age atthe time of operation was 52 years. There were 17 male patients and 28 females. 40 patients underwent two level fusion, and 5 patients underwent multilevel fusion. The Hb value was 124g/L preoperativeand 116g/L postoperative. The average intraoperative blood loss was 380 ml. The volume of intraoperative ACT was 320 ml. Drain output was 108 ml. There were no transfusion-related complications. Ingroup B, the average age at the time of operation was 58 years. There were 8 male patients and 17 females. 2 patients underwent two level fusion, and 23 patients underwent multilevel fusion. The Hb valuewas 122g/L preoperative and 109g/L postoperative. The average intraoperative blood loss was 800 ml. The volume of intraoperative ACT was 450 ml. Drain output was 178 ml. 3 patients suffered fever afterallogeneic blood transfusion.
引文
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[2]李方财,陈其昕,徐侃,等.经椎间孔腰椎椎体间融合术的早中期疗效.中华骨科杂志,2007,27:580-585.
[3]陈维善,朱丹杰,陈其听,等.经椎间孔腰椎椎体间融合术的初步疗效.中华外科杂志,2005,43:1102—1103.
[4]李永津,陈博来,林涌鹏.MAST Quadrant通道下微创TLIF与开放TLIF两种术式治疗腰椎退行性疾病的效果比较.广东医学,2015,9,1287-1289.
[5]姜建元,马昕,吕方舟.改良经椎间孔腰椎椎体间融合的解剖学研究及临床意义.中华外科杂志,2009,14,1100-1103.
[6]辛大奇,霍洪军,杨学军,等.改良TLIF技术结合椎间植骨融合内固定术治疗脱出型腰椎间盘突出症并椎间不稳.内蒙古医科大学学报,2015,1,29-33.
[7]Johnson RG,Murphy M,Miller M.Fusions and tranfusions:an analysis of blood loss and autologous replacement during lumbar fusions.Spine 1989;14:358–362.
[8]Nuttall GA,Horlocker TT,Santrach PJ,et al.Predictors of blood transfusions in spinal instrumentation and fusion surgery.Spine,2000;14:596–601.
[9]李建华,李斌,胡惠英,等.自体血回输对骨科手术患者组织氧代谢的影响.临床麻醉学杂志,2013,4,322-324.
[10]Savvidou C,Chatziioannou SN,Pilichou A,et al.Efficacy and cost-effectiveness of cell sav ing blood autotransfusion in adult lumbar fusion.Transfus Med.2009,19:202-206.
[2]李方财,陈其昕,徐侃,等.经椎间孔腰椎椎体间融合术的早中期疗效.中华骨科杂志,2007,27:580-585.
[3]陈维善,朱丹杰,陈其听,等.经椎间孔腰椎椎体间融合术的初步疗效.中华外科杂志,2005,43:1102—1103.
[4]李永津,陈博来,林涌鹏.MAST Quadrant通道下微创TLIF与开放TLIF两种术式治疗腰椎退行性疾病的效果比较.广东医学,2015,9,1287-1289.
[5]姜建元,马昕,吕方舟.改良经椎间孔腰椎椎体间融合的解剖学研究及临床意义.中华外科杂志,2009,14,1100-1103.
[6]辛大奇,霍洪军,杨学军,等.改良TLIF技术结合椎间植骨融合内固定术治疗脱出型腰椎间盘突出症并椎间不稳.内蒙古医科大学学报,2015,1,29-33.
[7]Johnson RG,Murphy M,Miller M.Fusions and tranfusions:an analysis of blood loss and autologous replacement during lumbar fusions.Spine 1989;14:358–362.
[8]Nuttall GA,Horlocker TT,Santrach PJ,et al.Predictors of blood transfusions in spinal instrumentation and fusion surgery.Spine,2000;14:596–601.
[9]李建华,李斌,胡惠英,等.自体血回输对骨科手术患者组织氧代谢的影响.临床麻醉学杂志,2013,4,322-324.
[10]Savvidou C,Chatziioannou SN,Pilichou A,et al.Efficacy and cost-effectiveness of cell sav ing blood autotransfusion in adult lumbar fusion.Transfus Med.2009,19:202-206.