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膝关节置换围术期不同血液管理方法的效果比较及相关研究
引用本文:齐佳健,安帅,曹光磊,冯明利,李征,沈惠良.膝关节置换围术期不同血液管理方法的效果比较及相关研究[J].北京医学,2017,39(7).
作者姓名:齐佳健  安帅  曹光磊  冯明利  李征  沈惠良
作者单位:首都医科大学宣武医院骨科, 北京,100053
摘    要:目的 探讨全膝关节置换术(TKA)围术期应用促红细胞生成素(EPO)、氨甲环酸(TA)、和自体血回输3种血液管理方法的疗效.方法 选取2013年5月至2014年12月在首都医科大学宣武医院行TKA的患者,采用数字表法将全部患者随机分为EPO组、TA组、自体血回输组和空白对照组,4组患者围术期采取不同的血液管理方法.比较患者术后Hb、异体输血、失血等数据,并计算隐性失血量,进行统计学分析.结果 共纳入108例患者,男20例,女88例;平均年龄(70.6±6.4)岁;BMI (26.97±3.51)kg/m2.EPO组31例,TA组28例,自体血组28例和空白对照组21例.对照组围术期Hb变化差值(43.7±8.2)g/L大于其他3组(36.8±13.6)、(35.0±8.7)、(27.1±14.8)g/L,差异有统计学意义(P< 0.05);EPO组、TA组、自体血回输组和对照组术后异体血输注率分别为19.4%、7.1%、32.1%和28.6%,TA组异体输血率显著少于其他3组,差异均有统计学意义(P<0.05);自体血组总失血量(1 536±438)ml,对照组(1 476±263)ml,明显多于EPO组(1 179±378)ml]和TA组(1 057±242ml)],差异有统计学意义(P<0.05).结论 应用EPO、TA、自体血回输3种血液管理方法均可以有效改善TKA的失血情况.3种方法中,TA可获得相对较好的疗效,但由于TKA失血较多,建议联合多种血液管理方法.

关 键 词:全膝关节置换术  围术期血液管理  隐性失血  氨甲环酸  促红细胞生成素  自体血

Comparison and association studies of different perioperative blood management during total knee arthroplasty
Qi Jiajian,An Shuai,Cao Guanglei,Feng Mingli,Li Zheng,Shen Huiliang.Comparison and association studies of different perioperative blood management during total knee arthroplasty[J].Beijing Medical Journal,2017,39(7).
Authors:Qi Jiajian  An Shuai  Cao Guanglei  Feng Mingli  Li Zheng  Shen Huiliang
Abstract:Objective To study the effect of three perioperative blood management approaches on perioperative blood loss during total knee arthroplasty(TKA).Methods A total of 108 patients who underwent TKA due to osteoarthritis were enrolled from May 2013 to December 2014.Patients were divided into four groups randomly using the number table:the EPO group,the TA group,the blood salvage group and the control group.Different perioperative blood managements were used in each group.The volume of drained blood and Hb levels postoperatively were measured.The number of patients requiring blood transfusion were recorded and compared.The perioperative hidden blood loss was calculated,then the total and hidden blood loss were compared.Results A total of 108 patients were enrolled in the study,20 were males,88 were females;and the average age was (70.6±6.4)years old;BMI was (26.97±3.51)kg/m2.There were 31 cases in the EPO group,28 cases in the TA group,28 cases in blood salvage group,21 cases in the control group.In the control group,the postoperative Hb decreased (43.7±8.2)g/L,which was significantly higher than that in the other 3 groups(36.8± 13.6),(35.0±8.7),(27.1±14.8)g/L(P < 0.05).Blood transfusion rate of the TA group(7.1%)was significantly lower than that of the other 3 groups (19.4%,32.1%,28.6%;P < 0.05).Total blood loss in blood salvage group(1 536±438)ml] and control group(1 476±263)ml] were more than EPO group(1 179±378)ml] and TA group (1 057±242)ml,(1 179±378) ml;P < 0.05)].Conclusion There is a large volume of peri-operative blood loss in TKA,the application of EPO,TA,and autologous blood transfusion can effectively alleviate the symptoms of anemia associated with TKA.TA get relatively better efficacy,but due to blood loss of TKA,so combined approaches are recommended for blood management.
Keywords:total knee arthroplasty(TKA)  perioperative blood management  hidden blood loss  tranexamic acid  erythropoietin(EPO)  blood salvage
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