【摘要】 目的比较限制性输血与开放性输血对髋关节置换术老年患者预后的影响。方法择期在蛛网膜下腔麻醉下行髋关节置换术老年患者206例,年龄65~90岁,ASAⅠ~Ⅲ级,随机分为两组:限制性输血组(维持80g/L≤Hb<100g/L,n=102)和开放性输血组(维持100g/L≤Hb<120g/L,n=104)。记录羟乙基淀粉输注量、红细胞输注率、围术期Hb、术中低血压发生率、住院时间,以及术后患者脑梗死、急性肺栓塞、肺炎、心肌梗死、伤口感染发生率及90d死亡率。结果两组患者一般资料、术前Hb浓度、住院时间、脑梗死、急性肺栓塞、心肌梗死、伤口感染发生率及90d死亡率比较差异均无统计学意义。与开放性输血组比较,限制性输血组羟乙基淀粉输注量、术中低血压发生率明显增加(P<0.05);而红细胞输注率、输血前及输血后Hb、肺炎发生率明显降低(P<0.05)。结论对行髋关节置换术的老年患者,限制性输血是安全的治疗策略。更多还原

【Abstract】 Objective To compare the effects on patientsoutcomes in aged patients undergoing total hip-replacement surgery between restrictive and liberal transfusion strategy.Methods Patients with ASA Ⅰ-Ⅲ,aged 65-90years,undergoing total hip-replacement with spinal anesthesia were randomized to two groups according to the maintained Hb concentrations during the surgery:restrictive transfusion strategy group(80g/L≤Hb<100g/L,n=102)and liberal transfusion strategy group(100g/L≤Hb<120g/L,n=104).The demographics,hydroxyethyl starch consumption,red blood cell transfusion percentage,perioperative Hb concentrations,hypotension incidence,length of hospital stay,brain infarction incidence,acute pulmonary embolism incidence,pneumonia incidence,myocardial infarction incidence,wound infection incidence,and 90 days mortality were recorded. Results There was no significant difference in the demographics,preoperative Hb concentrations, length of hospital stay,brain infarction incidence,acute pulmonary embolism incidence,myocardial infarction incidence,wound infection incidence,and 90daysmortality between the two groups.Compared with the liberal transfusion strategy group,the hydroxyethyl starch consumption and the hypotention incidence were higher but the red blood cell transfusion percentage,pre-and post-transfusion Hb concentrations,and pneumonia incidence were lower in the restrictive transfusion strategy group(P<0.05).Conclusion Restrictive transfusion strategy is an effective and safe strategy for aged patients undergoing total hip-replacement.更多还原