【摘要】 目的调查老年髋关节置换术输血的合理性,为患者血液管理积累经验。方法选取2016年1月至2017年3月于本院行单侧髋关节置换术的老年患者30例为研究对象,均于腰硬联合麻醉下完成人工股骨头置换术。术中常规使用血液回收机,将采集的自体红细胞于手术结束后输回患者体内。由骨科医师决定患者术后是否输注红细胞和输注单位数。麻醉科医师根据患者术后24小时血红蛋白(hemoglobin,Hb)测定结果将其分为零输血组(免输血手术)、合理输血组(Hb水平80~100 g/L)及欠合理输血组(Hb水平>100 g/L)。分别记录并比较三组患者术前Hb基础水平,术中自体红细胞回收量、术后异体红细胞输入量及术后24小时引流量和Hb水平。结果零输血组有10例(33%)患者,合理输血组14例(47%)患者,欠合理输血组6例(20%)患者。三组患者术中回收自体红细胞量和术后24小时引流量比较均无显著差异(P>0.05)。零输血组患者年龄显著低于合理输血组和欠合理输血组(P<0.01,P<0.05),术前和术后24小时Hb水平均显著高于合理输血组(P<0.01),欠合理输血组患者术前和术后24小时Hb水平均显著高于合理输血组(P<0.05,P<0.01)。结论老年髋关节置换术患者术后Hb水平>80 g/L是安全的,术后测定Hb水平有助于评估输血的合理性。更多还原

【Abstract】 Objective To investigate the rationality of the hip replacement blood transfusion, so as to accumulate experiences for patients blood management. Method 30 cases of elderly patients undergoing unilateral hip replacement from January 2016 to March 2017 in our hospital were selected as the subjects, they had operated on artificial femoral head replacement under spinalepidural anesthesia. Intraoperative blood salvage was routinely used and autologous red blood cels(RBCs) were returned back to all patients following surgery. The blood transfusion trigger of allogeneic RBCs and unite numbers was decided by the orthopedic surgeon. According to 24 h postoperative hemoglobin(Hb) measurement, the rationality of transfusion was classified by the anesthesiologist into zero transfusion group(bloodless surgery), reasonable transfusion group(Hb 80 ~ 100 g/L), unreasonable transfusion group(Hb > 100 g/L). The preoperative hemoglobin level, intraoperative autologus RBCs recovery volume, allogeneic RBCs transfusion unites and 24 h postoperative incision drainage volume and 24 h postoperative Hb level were measured among the three groups, respectively. Result There were 10 cases(33%) in zero transfusion group, 14 cases(47%) in reasonable transfusion group and 6 cases(20%) in unreasonable group. There were no significient differences in intraoperative autologus RBCs recovery volume and 24 h postoperative incision drainage volume among the three groups(P > 0.05). The result showed that age in zero transfusion group were significant lower than those of reasonable group and unreasonable group(P < 0.01, P < 0.05), respectively. The preoperative and 24 h postoperative Hb level in zero transfusion group were all significant higher than those in reasonable group(P < 0.01). The preoperative and 24 h postoperative Hb level in unreasonable group were also significant higher than those in reasonable group(P < 0.05, P < 0.01). Conclusion It is concluded that postoperative Hb > 80 g/L is a safe level. Early postoperative Hb measurement can help us to assess the rationality of blood transfusion.更多还原