【摘要】 背景:就目前来看,老年关节置换患者的数量呈现逐年增加的趋势。围置换期出血是关节置换重要的近期并发症,严重影响关节手术预后,增加其他并发症发生风险。较多输血或者止血措施纳入围置换期血液管理方案,但效果不一,存在不同的不良反应,存在个体差异。目的:旨在分析体质量指数及血脂水平与关节置换围置换期输血率的相关性,为关节置换围置换期血液管理提供依据。方法:从2011至2015年在常熟市第二人民医院就诊行全髋关节置换及全膝关节置换患者中,按照排除/纳入标准招募研究对象,收集研究对象基本信息,行关节置换术;收集统计围置换期研究对象输血率、预估失血量、失血百分比以及术后并发症发生情况;记录研究对象体质量指数及血脂水平,利用统计软件进行相关分析及回归分析。结果与结论:(1)2011至2015年共513例全髋关节置换及全膝关节置换患者纳入研究,平均年龄(76.1±9.2)岁,其中正常体质量指数组(正常组)124例,超重组229例,肥胖组160例;(2)全髋关节置换和全膝关节置换患者中正常组、超重组和肥胖组输血率组间差异有显著性意义(P=0.002,0.002);全髋关节置换和全膝关节置换不同组别失血量各组间差异有显著性意义(P=0.001,0.001);全髋关节置换和全膝关节置换不同组别平均失血量百分比组间差异有显著性意义(P=0.001,0.001);提示随着体质量指数上升输血率降低,总失血量提高,失血百分比越低;(3)手术部位深部感染发生率与体质量指数具有相关性(P=0.043),其他并发症发生率与体质量指数增长无关;(4)全髋关节置换组中总胆固醇水平与输血率、失血百分比呈负相关性(r=-0.278,P=0.021;r=-0.329,P=0.034),三酰甘油水平与输血率呈负相关性(r=-0.449,P=0.014);全膝关节置换组中总胆固醇水平与输血率、失血百分比呈负相关性(r=-0.341,P=0.006;r=-0.489,P=0.017);(5)对于全髋关节置换输血率,体质量指数、总胆固醇及三酰甘油水平为保护因素;对于全膝关节置换输血率,体质量指数和总胆固醇水平为保护因素;(6)结果表明,全髋关节置换和全膝关节置换患者输血率与体质量指数、总胆固醇及三酰甘油水平呈负相关;体质量指数较高患者总失血量增加,失血百分比降低,术后深部感染发生率增高。上述指标可以作为预测指标,应用于关节置换围置换期血液管理。更多还原

【Abstract】 BACKGROUND: At present, the number of patients with arthroplasty is increasing year by year. The perioperative hemorrhage is the short-term complication, which severely affects the patient’s prognosis and increasing the risk for other complications. More blood transfusions or hemostasis measures are included in the perioperative blood management programs, but with different effects and adverse reactions. OBJECTIVE: To analyze the relationship of body mass index(BMI) and blood lipid level with blood transfusion rate in the perioperative period of arthroplasty and provide evidence for perioperative blood transfusion management of total knee arthroplasty. METHODS: The patients undergoing total hip arthroplasty or total knee arthroplasty at the Changshu No. 2 People’s Hospital from 2011 to 2015 were recruited in accordance with the exclusion and inclusion criteria. The basic data of the participants were collected, and all patients accepted arthroplaties. The blood transfusion rate, pre-estimated blood loss, and percentage of blood loss and postoperative complications were recorded and analyzed; the BMI and blood lipid levels were recorded. Correlation analysis and regression analysis were conducted by the statistical software. RESULTS AND CONCLUSION:(1) Totally 513 patients were included in the study, with the mean age of(76.1±9.2) years old, 124 cases in normal BMI group, 229 cases in overweight group, and 160 cases in obesity group.(2) The blood transfusion rate showed significant difference among groups(P=0.002, P=0.002). There were significant differences in the blood loss and percentage of blood loss among groups(All P=0.001), suggesting that with BMI increasing, there was a decrease in blood transfusion rate and percentage of blood loss, and a increase in total blood loss.(3) The incidence of deep infection of the incision was correlated with BMI(P=0.043), and the incidence of other complications was not related to BMI.(4) In the total hip arthropalsty, the total cholesterol level was negatively related to the blood transfusion rate and percentage of blood loss(r=-0.278, P=0.021; r=-0.329, P=0.034), and the triglyceride level was negatively related to the blood transfusion rate(r=-0.449, P=0.014). In the total knee arthroplasty, the total cholesterol level was negatively related to the blood transfusion rate and percentage of blood loss(r=-0.341, P=0.006; r=-0.489, P=0.017).(5) For the blood transfusion rate in the total hip arthroplasty, BMI, total cholesterol and triglyceride levels were the protective factors, and in the total knee arthroplasty, the protective factors were BMI and total cholesterol level.(6) In summary, the blood transfusion rate is negatively related to the BMI, total cholesterol and triglyceride levels in patients undergoing total hip or knee arthroplasty. Patients with higher BMI have a higher total blood loss, lower percentage of blood loss and higher incidence of postoperative deep infection. The above indexes can be used as predictive indexes for the perioperative blood management in joint arthroplasty.更多还原