双侧全髋关节置换术中自体血回输作用探讨

目的 双侧全髋关节置换术病人经常需要输入大量术中及术后异体血,其危险性包括溶血反应、感染乙肝或丙肝、感染HIV或梅毒等.减少异体血输入的最常用方法是采用术中自体血回输.该回顾性研究旨在评价术中自体血回输能否具有减少双侧全髋关节置换术围手术期异体输血总量的作用.方法 自2003年1月至2007年6月期间,行双侧首次全髋关节置换术51例,其中26例采用术中自体血回输(A组),25例未用术中自体血回输(B组),回顾性比较两组病人的性别、年龄、体重、身高、疾病、手术医生、手术时间,术前血红蛋白及红细胞压积,术中出血量、自体血回输量、异体血使用量,术后引流量、异体血使用量,术后1、3、7天血红蛋白和红细胞压积.结果 A组术中自体血回输330.7±122.7ml (100～557ml).术中异体血输入量在A组为661.5±437.3ml,B组为888.0±483.3ml(P=0.085).术后异体血输入量在A组为607.7±672.9ml,B组为328.0±423.8ml(P=0.082).两组之间术中和术后异体血总输入量无统计学差异(A组1269.2±807.8ml,B组1216.0±706.9ml,P=0.804).两组之间术后第1天血红蛋白和红细胞压积无统计学差异,而术后第3天血红蛋白和红细胞压积有统计学差异(P=0.020和P=0.013),术后第7天血红蛋白和红细胞压积又无统计学差异.结论 双侧全髋关节置换术术中自体血回输能够减少术中异体输血量,但不能减少围手术期异体输血总量.     

自体血回输对青少年特发性脊柱侧凸患者围手术期细胞免疫功能的影响

目的：探讨自体血回输对青少年特发性脊柱侧凸患者围手术期细胞免疫功能的影响。方法：2002年2月～2005年2月，根据术中输血的方式将特发性脊柱侧凸患者148例分为2组，异体输血组(Ⅰ组)42例：术中全部输异体成分血；自体血回输组(Ⅱ组)106例：术中采用血液回收机将自体血回输给患者，使患者红细胞比容(HCT)≥30％，Hb≥10g／L，如果达不到低限，适量补充异体血。观察两组异体血输入量、过敏反应发生率；并分别于入手术室、术后第1天及第5天抽取静脉血，测定T细胞亚群和NK细胞的数量。结果：Ⅰ组平均异体血输入量850±170ml，Ⅱ组中有58例除了自体血回输外补充了异体血，平均410±150ml。输血反应发生率Ⅰ组为26．2％(11／42)，Ⅱ组为4．7％(5／106)，两组间存在显著性差异(P＜0．01)。两组术后第1天CD3~+、CD4~+、CD4~+／CD8~+、NK细胞较术前显著减少(P＜0．05或P＜0．01)，异体输血组较自体输血组减少更明显(P＜0．05)。术后第5天异体输血组CD3~+、CD4~+、CD4~+／CD8~+、NK细胞仍较术前显著减少，自体输血组基本恢复正常，两组间存在显著差异(P＜0．05)。结论：自体血回输可明显减少脊柱侧凸矫形患者异体血输入量，术后自体输血患者细胞免疫功能的抑制较异体血输入者轻，术后细胞免疫功能恢复快。     

自体输血在人工关节置换术的应用

目的人工髓、膝关节置换术后出血量较大,尤其是膝关节置换术后平均引流量达６００～８００ｍｌ,常需输血治疗。而异体输血可引起许多不良反应和并发症,因此自体输血技术日益受到重视。本文介绍自体输血的初步经验。方法自１９９１年起,我院骨关节科共对４３３例施行人工髋、膝关节置换术的患者采用了自体输血技术,主要方法包括术前预存自体血和术后引流血回输技术。结果单纯依靠术前预存自体血输血组,术后约有６９％（２５８／３７４）的患者无需异体输血而顺利渡过围手术期,其中９３．４％（２４１／２５８）为单侧关节置换患者,６．６％（１７／２５８）为双膝、双髋或单侧膝髋同时置换的患者;而在单纯术后引流血回输组和两种方法结合组,这一比例则分别为３６％（５／１４）和７５．６％（３４／４５）。结论采用术前预存自体血加术后引流血回输的方法,可使多数施行人工髋、膝关节置换术的病例避免了异体输血及由此带来的潜在危险。     

氨甲环酸联合术中自体血回输在THA中的应用

目的探讨氨甲环酸联合术中自体血回输在全髋关节置换术中应用的安全性及有效性和两者的治疗效果。方法 2019年1月至2020年12月行初次单侧全髋关节置换术患者60例,分成3组,每组20例。A组:术中未使用氨甲环酸和术中自体血回输。B组:术中使用氨甲环酸。C组:术中使用氨甲环酸和自体血回输。通过对3组患者术前第1天、术后第1天和术后第5天的凝血酶原时间、活化部分凝血激酶时间、纤维蛋白原、D-二聚体、血红蛋白、血小板、红细胞、白细胞、C-反应蛋白、血沉数值的比较,统计术中出血量、回输血量、术后引流量、总失血量、异体输血总量、异体血输血率,记录发生下肢肌间静脉血栓、下肢深静脉血栓、肺动脉栓塞并发症的数据,分析氨甲环酸、氨甲环酸联合术中自体血回输在全髋关节置换术中应用的有效性及安全性和两者的治疗效果。结果氨甲环酸联合术中自体血回输在全髋关节置换中的应用,可以减少围手术期的出血量、术中出血量、术后引流量、异体血的总输入量和异体血输血率。结论围手术期总出血量在1000ml左右的全髋关节置换手术,采用氨甲环酸联合术中自体血回输,可使大约65%的需要异体血输血的患者避免异体血输血,有效节约血液资源,临床上值得推广应用。     

人工关节置换术后伤口引流血自体回输的作用

[目的]评估人工关节置换术后伤口引流血自体回输的有效性及安全性。[方法]选取2009年2～5月间于本科行人工髋、膝关节置换术的30例患者作为研究对象,应用ContavacTMCBCⅡ自体血液回输器回输术后6h内伤口引流血,根据患者异体输血量、血红蛋白水平变化以及伤口引流血中红细胞形态评价引流血自体回输的有效性;根据患者有无发热、溶血反应、凝血功能障碍、肺栓塞、脂肪栓塞、全身感染等以评估引流血自体回输的安全性。[结果]平均每例患者伤口总出血量为(946±433)ml,自体血回输(622±313)ml,异体输血(233±348)ml;伤口引流血中红细胞形态完整,血红蛋白含量为99.67g/L,术后第1d较术后即刻血红蛋白显著降低。1例患者出现异常发热,无患者发生其他并发症。[结论]人工关节置换术后6h内的伤口引流血为有效血液成分,回输后能够减缓血色素下降速度,节省术后异体血用量,是一种安全、有效补充血液成分的方法。     

麻醉后预存自体血在人工关节置换术中的应用

目的探讨麻醉后即刻采集自体血,于人工关节置换术后回输的临床应用. 方法 2004年9月～2005年1月,对33例拟行人工关节置换术的患者,麻醉后即刻采集自体血400 ml,于术后回输.观察采血时患者血压变化、术后12、24及72 h血常规、伤口引流及感染情况.其中男17例,女16例,年龄33～81岁,平均62.4岁.类风湿性关节炎5例,股骨头坏死23例,膝关节骨性关节炎5例.单髋关节置换20例,双髋关节置换1例;单膝关节置换6例,双膝关节置换5例;单髋关节翻修术1例. 结果采血前后血压无明显变化.术后回输血200～1 150 ml,平均650 ml.其中21例单髋关节置换患者仅回输预存自体血;6例单膝关节置换患者回输预存自体血后又将引流血回输;5例双膝及1例双髋关节置换的患者除用预存自体血和引流血回输外,因术后出血较多,输入异体血400 ml.术后血红蛋白68～102 g/L,平均88 g/L;红细胞压积20.5%～31.5%,平均24.6%,与术前比较差异均有统计学意义（P〈0.01）.术后伤口无感染、下肢静脉无血栓发生.6例输入异体血的患者,输血后2例出现寒战、皮肤骚痒等过敏反应,予地塞米松后症状均缓解. 结论对行人工膝、髋关节置换术的患者术前预存自体血供术后回输,可减少术后输入异体血带来的危险.     

血液稀释法自体输血在脊柱侧凸后路手术中的应用

目的：探讨在脊柱侧凸矫形术中应用血液稀释法自体输血的可行性。方法：３６例脊柱侧凸患者在行后路器械矫形融合术中采用了血液稀释法自体输血。２０例患者术接受了预存自体输血,其中４例患者又应用了术中自体血回输。结果：平均轴血量为６２７ｍｌ（４２５～８３４ｍｌ）,血液稀释后红细胞压积达２９．８％。２０例平均预存血量为６５０ｍｌ。术中术后平均总失血量１８５０ｍｌ,平均异体血输入量７５０ｍｌ。４例应用术中自体血回输患者均未输异体血而安全度过手术期。所有患者在血液稀释采血后血红蛋白、红细胞压积均明显下降,术后１周基本恢复正常,未发现应用血液稀释法采血的相关并发症。结论：血液稀释法自体输血能有效减少异体血的输入量,且安全有效、节约区费;联合应用多种自体输血方法可大大减少甚至无需异体血输入。     

人工膝关节表面置换术后自体引流血回输的效用

目的人工膝关节表面置换术后常常需要输血治疗,输异体血的弊端在于可能导致传染性疾病的传播,配型不合导致输血反应或免疫调节反应。另外异体血血源紧张,费用昂贵,因此临床上应尽量减少异体输血。关于自体血回输器的应用文献报道效果不一,本文旨在探讨人工膝关节表面置换术后自体引流血回输的效用。方法使用回顾性质量评估设计,我们比较了136例择期行人工膝关节表面置换的病人和历史上同样行膝关节表面置换的116例病人。研究组使用了Consta VacTMCBC自体血回输器,伤口血液经回输器过滤后回输。对照组的引流血液被弃置。根据病人的临床表现和血红蛋白水平决定异体血的回输量,使术后血红蛋白水平维持在10 g/dL以上。比较两组术前及出院时的血红蛋白水平和输异体血的量和比例。结果两组间术前和出院时的血红蛋白水平没有统计学差异。输异体血的比例在单膝置换时,未回输组为27.3%,回输组为14.3%。在双膝置换时,未回输组为85.2%,回输组为45.1%。结论使用自体血回输器可以减少人工膝关节表面置换术后输异体血的比例和输血量。     

自体血回输技术在脑外伤手术患者中的应用

目的探讨回收式自体血回输在脑外伤手术中的应用效果。方法本院2012年1月至2013年12月,实施脑外伤手术,选择无自体血回输禁忌症且预计出血量大于600ml的90例患者随机分成两组,每组45例：对照组A组、术中回收式自体血回输组（研究组）B组,对患者手术前（T1）、手术结束（T2）、术后24小时（T3）患者的凝血功能及红细胞（RBC）、血红蛋白（HGB）、红细胞压积（Hct）进行检测,记录输血量,以及评价并发症。结果应用回收式自体血回输组48%的患者避免了术中、术后异体血的输入,而对照组仅9%的患者不需输入异体血。以对照组相比,自体血回输患者异体输血量平均每例比对照组少输293ml,自体血回输再回收率约49%,各组术前、手术结束、术后24小时血液中的RBC、Hb、Hct及凝血功能检测数据大致正常。结论自体血液回输用以脑外伤患者是安全且有效的方法,可以及时获得大量新鲜血液对患者进行抢救,同时节省异体血用量,并且可以避免血液传播性疾病的发生,对患者影响小、并发症低,可安全应用于脑外伤手术。     

自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用

目的观察术前自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用。方法60例骨科择期手术患者（预计出血量〉1000ml,ASAⅠ～Ⅱ级）,随机分为3组,每组20例患者。Ⅰ组采用术前自体血小板分离联合术中自体血回输,Ⅱ组采用单纯术中自体血回输,Ⅲ组不进行任何血液保护措施。各组分别于麻醉前、血小板分离后10min、保存的血小板或自体血回输前10min、回输后10min、术后24h、术后48h检测相应时点的血红蛋白水平、凝血功能、血小板水平和聚集功能、术中术后出血量及异体输血情况。结果三组的一般资料、术中出血量、术中术后的血红蛋白水平比较未见明显差异。与Ⅰ组相比,Ⅱ、Ⅲ组术后24h和术后48h的血小板水平和聚集功能明显降低（P〈0．05）,术后出血量及异体输血率则明显增高（P〈0．01）。结论术前自体血小板分离联合术中自体血回输可明显改善骨科手术患者的凝血功能,并有效降低术后出血量和异体血的输注。     

An economic justification for autologous blood re-infusion in primary total knee replacement surgery

INTRODUCTION: To justify economically the use of autologous blood re-infusion after total knee replacement surgery compared with vacuum drains. To determine if the patients using autologous re-infusion units have a reduced allogenic blood transfusion requirement and hospital stay. PATIENTS AND METHODS: Prospectively, 50 patients undergoing primary unilateral total knee replacements with autologous re-infusion units were studied. They were matched for age, sex, type of prosthesis and the month in which surgery took place to a second group undergoing the same surgery with vacuum drains. The results for the second group were obtained retrospectively from the notes. The outcome measures were the need for allogenic blood transfusion and length of postoperative hospital stay. RESULTS: The use of re-infusion units reduced the need for postoperative allogenic blood transfusion from 28% to 4% in total knee replacement surgery. The cost of using re-infusion units was the same as vacuum drains. Overall, the autologous re-infusion patients were discharged 2 days earlier (99% confidence interval). CONCLUSIONS: Re-infusion units are no more expensive than vacuum drains. In addition, autologous blood has many clinical benefits compared to allogenic blood. Re-infusion may shorten the hospital stay for patients undergoing total knee replacement surgery.     

Investigation of the use of drained blood reinfusion after total knee arthroplasty: a prospective randomised controlled study

PURPOSE: To compare the use of a blood salvage and reinfusion system with standard allogeneic blood transfusion after total knee arthroplasty--a procedure associated with significant postoperative blood loss. METHODS: Between June 2002 and May 2004, 60 patients undergoing total knee arthroplasty were randomly allocated into a reinfusion group (n = 26) or a control group (n = 34). Patients in the reinfusion group had their blood reinfused from drains within 6 hours of surgery. Both groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin level fell below 90 g/l, or in the presence of severe anaemic symptoms. Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery. RESULTS: There was no significant difference between the 2 groups in demographic data, drain output, total blood loss, and mean postoperative haemoglobin levels. Significantly more allogeneic blood was required by the control group than by the reinfusion group (p = 0.022). CONCLUSION: Postoperative reinfusion of drained blood reduced the need for blood transfusion after total knee arthroplasty, while having an effect on postoperative haemoglobin level equivalent to standard allogeneic blood transfusion.     

Postoperative autologous blood salvage drains--are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases

There are nearly 43,000 hip replacements and 33,000 knee replacements performed each year in the United Kingdom. Many of these require a blood transfusion. However, there has been increased public concern about the safety of blood transfusion and various techniques are used to decrease the need for allogenic transfusion. Postoperative blood salvage and reinfusion is one of them. We studied 186 consecutive patients who underwent unilateral uncemented hip or knee arthroplasty. Ninety-four had re-infusion drains and 92 had suction drains. We have compared the allogenic transfusion requirements for the two groups. We have analyzed patient and operative factors to determine whether they are predictive for risk of allogenic blood transfusion. Cost analysis was performed to determine whether the use of a re-infusion drain is a cost effective technique. Re-infusion drains significantly decreased the requirements for allogenic blood transfusion (p = 0.001). Twenty-one percent of the re-infusion drain group and 45.7 % of the suction drain group required allogenic blood transfusion. The only preoperative factor that determined whether the patient required allogenic blood transfusion was pre-operative haemoglobin. We found that age, gender, type of surgery (hip replacement or knee replacement) and whether the patient had tourniquet or not (in knee replacement) did not alter the requirements for allogenic blood transfusion. The mean transfusion costs were slightly less for re-infusion drain group (? 182.70 per patient for re-infusion drain group and ? 196.75 per patient for suction drain group, p = 0.009). The hospital stay was also significantly reduced (11.0 days for re-infusion drain group as opposed to 12.6 days for suction drain group (p = 0.0248). Based on these findings, re-infusion drains appear as a cost effective means of reducing the requirement for allogenic blood transfusion following primary hip and knee arthroplasty.     

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous, banked blood transfusions in total knee arthroplasty. We carried out a prospective randomised controlled study on 60 patients having unilateral total knee replacements. In all these patients, the same surgical team applied the same surgical technique, and all patients followed the same rehabilitation program. In 30 of these patients (group A), a reinfusion system of unwashed salvaged blood was applied, and they were supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required. The administration of banked blood transfusion was determined by the haemoglobin value (<9 mg/dl) and/or clinical signs (blood pressure, pulse, etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the first, fifth and 15th postoperative days, respectively. Five patients of group A required nine units of homologous blood (0.3 units/patient) postoperatively. Ten patients of group B required an additional 15 banked blood units postoperatively (in total 45 banked blood units for group B; 1.5 units/patient). In the study group, the total homologous blood requirements were reduced by 80%, while the postoperative blood requirements were reduced by 50%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups. The cost of the blood management in the study group was reduced by 36%. The use of an autologous blood reinfusion system reduces highly effectively the demands of homologous banked blood transfusion in total knee arthroplasty.     

A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty

We undertook a prospective, randomised study in order to evaluate the efficacy of clamping the drains after intra-articular injection of saline with 1:500 000 adrenaline compared with post-operative blood salvage in reducing blood loss in 212 total knee arthroplasties. The mean post-operative drained blood volume after drain clamping was 352.1 ml compared to 662.3 ml after blood salvage (p < 0.0001). Allogenic blood transfusion was needed in one patient in the drain group and for three in the blood salvage group. Drain clamping with intra-articular injection of saline with adrenaline is more effective than post-operative autologous blood transfusion in reducing blood loss during total knee arthroplasty.     

Can local administration of tranexamic acid during total knee arthroplasty reduce blood loss and transfusion requirements in the absence of surgical drains?

Blood transfusions are frequently required following total knee arthroplasty. Tranexamic acid (TXA) inhibits fibrinolysis and has been shown to reduce blood loss and transfusion requirements when delivered intravenously. Topical and intra-articular applications directly target bleeding sites whilst limiting systemic uptake and theoretically reduce the risk of thromboembolic complications. However, in the absence of surgical drains, which increase post-operative blood loss, the efficacy of these techniques for reducing transfusion requirements is unclear. Our aim was to determine if locally administered tranexamic acid during total knee arthroplasty could reduce both blood loss and transfusion requirements in the absence of surgical drains. A retrospective review of 248 patients treated with primary unilateral cemented total knee arthroplasty was performed. Patients treated after January 2011 received topical and intra-articular tranexamic acid at the end of the procedure (n = 136). A second group of consecutive patients treated before this period acted as historical controls (n = 112). Patient groups were equivalent in terms of age, gender and ASA grade. There was a significant reduction in mean blood loss of 246 ml between the groups (p < 0.01). In addition, the requirement for post-operative allogenic blood transfusion was significantly reduced from 15.5 to 5.4 % after introduction of the tranexamic acid regimen (p = 0.02). This is the largest patient cohort reviewed to measure the efficacy of locally administered tranexamic acid during total knee arthroplasty and demonstrates that this is an effective technique for reducing both blood loss and transfusion requirements in the absence of surgical drains.     

Delayed release of drain in total knee replacement reduces blood loss. A prospective randomised study

Total knee arthroplasty is sometimes associated with major post-operative bleeding, often requiring transfusion. A prospective, randomised study was undertaken to assess the effect on post-operative bleeding of delaying release of the clamp on the suction drains. One hundred patients were allocated into two groups: Group A- immediate release of drain following release of tourniquet, and Group B- delayed release of the drain clamp by one hour. There was a statistically significant reduction (p = < 0.001) in postoperative bleeding between group A (1050 ml; 95%CI 728 - 1172 ml) compared to group B (732 ml; 95% CI 620- 845 ml). Average drop in corrected haemoglobin and postoperative transfusion requirement were also less in the delayed group. The results show that delaying release of the drains by one hour reduces postoperative blood loss and transfusion requirement following total knee arthroplasty.     

Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial

Total knee replacement in severe osteoarthritis usually requires extensive soft tissue releases often associated with considerable bleeding. In a prospective, randomised trial we compared postoperative conventional suction drainage versus four hour clamping drainage in 60 patients undergoing total knee arthroplasty for severe osteoarthritis. We compared blood loss, number of transfusions, postoperative complications and knee function and found significantly less postoperative blood loss through the drains (p < 0.001), and fewer blood transfusions (p = 0.09) were needed in the clamped group. We conclude that clamping drainage after total knee arthroplasty in severe osteoarthritis reduces blood loss through the drains and the need for blood transfusions.     

Tranexamic Acid to Reduce Blood Loss After Bilateral Total Knee Arthroplasty : A Prospective, Randomized Double Blind Study

The effects of 2-dosage regimens of tranexamic acid (10 mg/kg and 15 mg/kg) on blood loss and transfusion requirement were compared to saline placebo in 60 patients undergoing concurrent bilateral total knee arthroplasty, with additional reinfusion autotransfusion from intraarticular drains. Mean blood loss was 462 mL in 15 mL/kg group, 678 mL in 10 mg/kg group, and 918 mL in controls (P < .01 vs 15 mg/kg). Blood available for autotransfusion was greatest in controls and least in 15 mg/kg group. Combined autologous and allogenic transfusion volumes were similar in the treatment groups and significantly less than controls (P < .01). With use of an autologous reinfusion strategy, the lower dose is sufficient to lead to a lesser allogenic transfusion requirement.     

Postoperative re-perfusion of drained blood in patients undergoing total knee arthroplasty: is it effective and cost-efficient?

The value of postoperative salvage and re-infusion of drained blood was assessed in 155 patients undergoing total knee arthroplasty for primary knee osteoarthritis. In group A (n = 77), standard vacuum drains were used. In group B (n = 78), an auto-transfusion system was used and the blood drained within 6 hours postoperatively was re-infused. Group B patients were further distributed into 2 subgroups, in one of which methylprednisolone was administered before blood re-perfusion. Patients who received autologous blood had higher levels of haemoglobin at 8 hours (p < 0.05) and 24 hours postoperatively (p < 0.01) and needed less allogeneic blood transfusion (p < 0.01). Methylprednisolone administration was found to attenuate the postoperative febrile reaction (p = 0.01).