【摘要】 目的探讨全膝关节置换术后(totalkneearthroplasty,TKA)未洗涤伤口引流血回输在凝血功能上的安全性。方法选择2000年5~7月间行TKA的患者30例46膝,男7例,女23例;年龄29~75岁,平均56.9岁;骨关节炎15例,类风湿性关节炎15例;单侧膝关节置换14例,双侧膝关节同时置换16例。术后常规使用Stryker公司的CBCⅡConstaVacTM型回输血器予以自体伤口引流血回输,同时检测患者和伤口引流血中凝血因子的变化。结果(1)患者术后6h静脉血及术后2~6h伤口引流血中的纤溶酶原和抗凝血酶Ⅲ均低于术前静脉血,而术后2~6h伤口引流血中的纤溶酶原和抗凝血酶Ⅲ也低于术后6h静脉血,差异均有非常显著性意义(P<0.01);(2)术后2~6h伤口引流血中的纤维蛋白原未测到,术后6h静脉血中的纤维蛋白原低于术前静脉血,差异有非常显著性意义(P<0.01);(3)以上所能测出的数值大部分在正常范围内,临床上未见到凝血功能异常及DIC发生;(4)D-二聚体术前多处于正常范围内(<200ng/ml),而术后2~6h伤口引流血及术后6h静脉血中几乎全部大于2000ng/ml。(5)性别、术式及病因对凝血因子的变化无影响。结论TKA术后伤口引流血中凝血因子虽然有显著性变化,并有引起血栓形成的潜在危险,但未经洗涤的伤口引流血回输给患者,在凝血功能上是相对安全的。更多还原

【Abstract】 Objective To evaluate the quality of unwashed and filtered shed blood and the safety of coagulation while refusing this kind of blood to patients after total knee replacement. Methods From May 2000 to July 2000, 30 patients underwent total knee replacement consecutively. All patients received blood transfusion of unwashed autologous wound drainage blood from the operative knees, and the drainage blood was collected routinely by ConstaVacTM blood conservation system (Stryker Company). Coagulative factors from patients peripheral blood before and after the operation and shed blood were measured, such as fibrinogen, AT-Ⅲ, D-Dimer and plasminogen. PT and APTT were also measured. There were 7 males and 23 females, with the average age of 56.9 years old (29-75 years); 15 patients were diagnosed as osteoarthritis, 15 patients were rheumatoid arthritis. 14 cases underwent unilateral TKR and 16 bilateral TKR. Results 1) The levels of plasminogen, AT-Ⅲ in postoperative peripheral blood (6 hours after surgery) and shed blood (2-6 hours after surgery) were lower than those of preoperative peripheral blood; the levels of plasminogen, AT-Ⅲ in shed blood (2-6 hours after surgery) were also lower than those of postoperative peripheral blood (6 hours after surgery). All of the differences were significant by t-test with the confidence of 99%. 2) There was no fibrinogen in postoperative wound drainage blood, and 6-hour postoperative peripheral blood fibrinogen level was significantly lower than preoperative blood fibrinogen level. 3) All the values above were almost in normal range. No clinical evidence of coagulation and DIC was noted in these patients after transfusion of unwashed autologous wound drainage blood. 4) All the values of D-Dimer in preoperative blood were normal (under 200 ng/ml), but those in postoperative peripheral blood (6 hours after surgery) and shed blood (2-6 hours after surgery) were almost above 2 000 ng/ml. 5) Sex, operation method and diagnosis had no effects on coagulative factors. Conclusion There are significant changes of coagulative factors in unwashed, filtered shed blood after total knee replacement, it may produce a risk of coagulopathy due to refusal of this kind of blood, in fact, autologous wound drainage blood appears to be relatively safe to patients clinically.更多还原