单髁置换术与全膝置换术围手术期失血量比较

[目的]比较单髁关节置换术(UKA)与全膝关节置换术(TKA)治疗膝骨关节炎的围手术期失血量。[方法]回顾性分析本院收治的膝关节骨关节炎患者199例,94例接受UKA治疗,105例接受TKA治疗,对比两组患者手术时间、围手术期失血量,围手术期Hb和HCT减少量、术后住院天数。同时分析其与手术时间、术后住院天数是否存在相关性。[结果] UKA组手术时间显著短于TKA组,组间差异有统计学意义(P0.05)。UKA组围手术期总失血量、显性失血量、隐性失血量均显著少于TKA组,差异有统计学意义(P0.05),UKA组隐性失血量占实际失血量的69.22%,而TKA组占64.95%。UKA组术后Hb减少量、术后HCT减少量明显低于TKA组,差异有统计学意义(P0.05)。UKA组术后住院天数明显少于TKA组,差异有统计学意义(P0.05)。所有患者总失血量(r=0.245, P0.001)、显性失血量(r=0.216, P=0.002)、隐性失血量(r=0.176, P=0.013)均与手术时间存在着明显的正相关性,而与术后住院天数无明显相关性(P0.05)。UKA组患者手术后均无需输血治疗,TKA组有2例患者需输血治疗。[结论]与TKA手术比较,UKA手术具有手术时间短、总失血量少、术后住院天数少等特点。但无论是TKA或是UKA手术方式,术后隐性失血量占总失血量百分比较大,且手术时间与围手术期总失血量呈明显正相关。     

TKA术后放置引流与否对围手术期失血量的影响

目的 比较初次单侧全膝关节置换(MA)术后膝关节腔内放置引流与否对对围手术期失血量的影响.方法 初次行TKA 60例,分为引流组和非引流组,每组各30例.通过Gross方程推算总失血量(显性失血量+隐性失血量),对两组患者计算结果 进行回顾性分析.结果 引流组总失血量平均为(785.3t293.0)ml,显性失血量平均...     

糖尿病对膝关节置换术失血及早期疗效的影响

[目的]探讨糖尿病(DM)对初次全膝关节置换术围手术期失血量及术后功能康复的影响。[方法]回顾总结在本院行初次TKA治疗且符合纳入标准的膝骨关节炎病例269例,归为糖尿病组114例,非糖尿病组155例。比较两组围手术期失血量、住院时间、VAS评分等,采用HSS评分评价两组患者的术后功能。[结果]术后3 d糖尿病组的Hb及Hct均显著低于非糖尿病组(P0.05),糖尿病组的显、隐性失血量及理论总失血量均多于非糖尿病组,差异有统计学意义(P0.05)。糖尿病组病例住院时间显著长于非糖尿病组(P0.05)。术后3 d时糖尿病组VAS评分和患肢肿胀程度均大于非糖尿病组,差异有统计学意义(P0.05)。术后4周时糖尿病组HSS评分显著低于非糖尿病组(P0.05),但术后12周时两组间差异无统计学意义(P0.05)。所有患者均无切口感染、症状性肺栓塞等并发症。[结论] DM可使TKA围手术期出血量增加,并延缓术后功能恢复。     

加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析

目的探讨加速康复流程下人工全膝关节置换术(total knee arthroplasty,TKA)患者术后留置尿管的危险因素。方法以2017年1月-2018年8月全麻下初次单侧TKA患者为研究对象,其中205例符合选择标准纳入研究。收集患者临床资料,包括年龄、性别、体质量指数,术前关节活动度、美国特种外科医院(HSS)评分、美国麻醉医师协会(ASA)评分、疾病类型、合并症、血红蛋白、血细胞比容、血容量,手术时间及时刻、术后是否留置引流管、术中失血量、总失血量,术前、术中、术后补液量以及手术当天总补液量,手术当天小便量。采用单因素及logistic回归分析术后留置尿管的危险因素。同时,比较留置或未留置尿管患者术后住院时间以及围术期并发症发生情况,包括肌间静脉血栓、下肢深静脉血栓、肺栓塞形成,切口红肿渗出,电解质紊乱,恶心呕吐,尿路感染。结果205例患者中41例术后留置尿管,发生率为20.0%。单因素分析显示,年龄、性别、术后留置引流管、手术当天总补液量和小便量是初次单侧TKA术后留置尿管的影响因素(P<0.05)。多因素分析显示,男性和手术当天小便量多是初次单侧TKA术后留置尿管的危险因素(P<0.05)。与留置尿管组相比,未留置尿管组患者术后住院时间明显缩短、尿路感染发生率明显降低,差异有统计学意义(P<0.05);两组其他围术期并发症发生率差异均无统计学意义(P>0.05)。结论加速康复流程下,男性和手术当天小便量更多的患者在全麻初次单侧TKA后需留置尿管的风险更高。     

人工全膝关节置换术围手术期的血液管理

人工全膝关节置换术(total knee arthroplasty,TKA)需要广泛松解软组织、截除关节面以及暴露髓腔,故初次的单侧TKA术后出血量较多,大约在300~2200 ml[1],约有44%的患者需要输血治疗以纠正术后贫血[2,3]。如果贫血状态得不到纠正会严重影响患者的预后,如增加感染风险、延缓术后康复、增加致残率和死亡率以及延长住院时间[4]。所以在TKA围手术期,做好血液管理显得尤为重要,下面就将其研     

股骨干骨折髓内固定患者围手术期失血量评估及相关因素分析

[目的]对股骨干骨折髓内固定患者围手术期失血量进行评估并对影响因素进行分析比较。[方法]回顾性分析2012年3月~2014年3月于本院创伤骨科收治的81例股骨干骨折患者(男37例,女44例)病例资料,收集患者入院时、术前1 d和术后1 d血红蛋白和红细胞压积、术中出血量、自异体输血量等资料。根据Gross方程和Nadler方程计算围手术期总失血量、隐性失血量;计算围手术期隐性或显性失血量占比和术前/术后隐性失血量占比;比较分析年龄、性别、手术时间、受伤与手术的时间间隔、是否合并糖尿病、高血压等因素对失血量的影响。[结果]股骨干骨折髓内固定显性失血量(216.9±118.3)ml显著低于隐性失血量(451.4±225.9)ml(P0.05);术前隐性失血量(134.3±73.7)ml显著低于术后隐性失血量(317.1±215.7)ml,且差异具有统计学意义(P0.05)。糖尿病患者组显性失血量和总失血量(570.2±216.9)ml和(781.9±218.9)ml,明显高于非糖尿病组患者显性失血量(361.1±189.4)ml和总失血量(581.9±248.1)ml(P0.05);高血压组患者显性失血量(275.9±203.8)ml、隐性失血量(519.19±239.2)ml和总失血量(795.0±231.4)ml均分别明显高于非高血压组患者显性失血量(174.3±220.6)ml、隐性失血量(402.59±204.6)ml和总失血量(576.7±232.6)ml,差异具有统计学意义(P0.05)。[结论]股骨干骨折髓内固定围手术期隐性失血现象不容忽视;对于高能量损伤患者应密切关注围手术期血红蛋白水平变化;基础疾病可能会增加其围手术期失血量。     

全膝关节置换是否封堵股骨髓内定位孔比较

[目的]探究全膝关节置换术（total knee arthroplasty, TKA）中股骨髓内定位孔封堵对围术期失血量的影响。[方法]2019年10月—2021年10月就诊于本院拟行初次单侧TKA的60例患者纳入本研究,随机将患者分为两组。其中,30例术中使用骨塞将股骨髓内定位孔进行封堵,另外30例未将定位孔进行封堵,其余两组操作皆相同。比较两组早期临床及检验结果。[结果]两组手术时间、切口长度、术后首次下床时间、住院时间差异均无统计学意义（P>0.05）。封堵组在术中出血量[(278.7±41.3) ml vs (319.7±50.9) ml, P<0.001]、总失血量[(1 155.7±260.4) ml vs (1 312.0±228.3) ml, P=0.016]均显著少于开放组。平均随访时间（10.6±2.4）个月,术前两组间VAS、HSS评分差异均无统计学意义（P>0.05）,封堵组术后1 d [(6.7±0.4) vs (7.1±0.5),P=0.010]、7 d的VAS评分[(5.4±0.6) vs (6.3±0.6), P<0.001],及...     

个性化膝关节置换围术期血液管理方案的临床疗效评价

[目的]对行初次全膝关节表面置换术患者的个性化围术期血液管理方案进行临床疗效评价。[方法]对2011年12月~2016年12月在本院关节外科进行初次单侧全膝关节表面置换术的478例病例进行回顾性分析。实施围术期血液管理方案的患者共263例为试验组;未施行围术期血液管理方案的患者共215例为对照组。分别记录两组的术前及术后血红蛋白含量(术后第3 d),术中出血量,术后引流量,血制品输注量及住院时间。[结果]试验组患者术中出血量、术后引流量、输血量和输血率、术后血红蛋白下降量均少于对照组,差异均有统计学意义(P0.05)。另外,试验组患者的平均住院日稍高于对照组,但差异无统计学意义(P0.05)。[结论]依据患者实际情况,制定和应用个性化全膝关节置换术围术期血液管理方案十分必要,可以减少围手术期失血,促进患者早期恢复。     

氨甲环酸联合冰盐水及术后冰敷对减少人工膝关节置换围手术期失血的疗效分析

正人工膝关节置换(TKA)是治疗晚期膝关节骨关节炎的一种常规手术,术中大面积截骨,软组织松解、切除,必然导致术中、术后显性失血及隐性失血增多~[1-2]。氨甲环酸对于TKA减少围手术期失血,具有重要的意义~[3-4]。笔者自2013-01—2015-01诊治78例初次行单侧TKA患者的临床资料,分为试验组(42例除静脉应用氨甲环酸20 mg/kg外并关节腔内灌注溶有2 g氨甲环酸80 ml 4℃冰盐水,且术后患膝周围间     

加速康复外科模式下全膝关节置换术围术期限制性输液的临床研究

[目的]探讨加速康复外科模式下全膝关节置换术围术期限制性输液的安全性和有效性。[方法]回顾分析2015年7月~2016年1月行初次单侧全膝关节置换术手术当日自由性输液患者90例(对照组)和2016年2月~8月手术当日限制性输液患者70例(限制组)的临床资料。记录并比较两组患者围术期出入量情况、生命体征及不良事件发生情况。[结果]限制组手术当日平均输液量显著低于对照组[(1 532.76±296.51)ml vs(2 303.13±313.35)ml,P<0.001]。两组在手术时间、总失血量、术后每小时尿量、围术期血压及心率、术后住院时间方面差异无统计学意义(P>0.05)。限制组利尿剂及尿管使用率均低于对照组(11.40%vs 24.40%,P=0.036;15.70%vs 30.00%,P=0.035),但两组术后低血压、低钾血症、恶心呕吐、便秘发生率差异并无统计学意义(P>0.05)。[结论]加速康复外科模式下全膝关节置换术围术期采用限制性输液方案(手术当日输液量控制在1 500 ml左右)是安全有效的,但该结论仍需大样本前瞻性研究进一步证实。     

Crystalloids,colloids, blood,blood products and blood substitutes

Understanding the physiology of fluid distribution within the human body is fundamental to the practice of anaesthetists and intensivists of all grades. There is a necessity to recognize the range of actions and consequences of the commonly infused intravenous fluids if safe patient care is to be provided. There are many historical and on-going trials surrounding fluid therapy and it is important for the physician to keep up to date with current guidelines.There is a continued drive to improve the safety of donor blood and prevent transfusion errors. Knowledge of how blood products are collected separated and stored is essential to prevent harm to patients through transfusions. Work in producing blood substitutes is progressing, but to date, trials have failed to market a product in Europe and the USA with an acceptable risk profile.     

Perioperative blood and blood component therapy

This overview examines blood, blood components, their indications and contra-indications, from an anaesthetist's viewpoint. The dangers of any blood transfusion, including infection transmission and immune suppression, as well as the risks of massive and rapid transfusions, are discussed. Autologous predonation, intraoperative haemodilution and salvage are described to help prevent some of the risks of homologous blood transfusion. Preoperatively an acceptable individualised haemoglobin concentration should be calculated for each patient and a history for potential bleeding problems taken. In most patients perioperative anaemia does not adversely influence patient morbidity and mortality. However, if blood is required, 4 ml.kg-1 body weight of packed red blood cells will raise the patient's haemoglobin concentration by 1 g.dl-1. The bleeding time as a test of platelet function does not predict perioperative blood loss. However, it remains a useful test in patients with a known bleeding problem or in operations where even small amounts of bleeding increase the surgical difficulty and patient morbidity. If bleeding is due to thrombocytopaenia it is usually slow enough to allow time to check platelet number and function before ordering and transfusing them. Fresh plasma is a much overused product which should mainly be used for coagulation factor replacement, in adequate volumes (4-8 packs in dilutional coagulopathy). The well-informed anaesthetist should be better able to use blood products which, while they may be life saving, are neither innocuous nor inexpensive.     

Crystalloids,colloids, blood,blood products and blood substitutes

The choice of fluid in a given clinical scenario relies on knowledge of the physiology and pharmacology of the fluid. A broad range of fluids are discussed in this article, with particular emphasis on problems associated with excess administration of 0.9% saline. Colloids, blood, blood products and blood substitutes are also discussed. Balancing the risks of allogenic blood transfusion for a patient and transfusion thresholds are considered. The potential of haemoglobin substitutes are still yet to be realized; however PolyHeme is currently in a phase 3 pre-hospital trauma trial.     

Ambulatory blood pressure monitoring: mean blood pressure and blood pressure load

Ambulatory blood pressure monitoring (ABPM) is commonly used to diagnose pediatric hypertension. Using ABPM, hypertension is usually defined as a mean BP greater than the 95th percentile for height. A BP load >30% (% of BP readings greater than the 95th percentile) is also used for the diagnosis of hypertension. The objective of this study was to determine the agreement between mean BP greater than the 95th percentile and 30% BP load for the diagnosis of hypertension using ABPM. All ABPM records (n =1,009) of patients referred for hypertension to a pediatric center were retrieved. Scans were excluded if: age was >19 and height <115 cm or >185 cm. Mean BP and BP loads were calculated for 728 scans. Agreement between mean BP greater than the 95th percentile for height and various BP loads were calculated using the kappa coefficient. The kappa coefficient of agreement between mean BP greater than the 95th percentile and 30% BP load was 0.56 and 0.57 for daytime systolic and diastolic BP, respectively. The agreement between mean night-time BP greater than the 95th percentile and 30% BP load was 0.70 and 0.66 for systolic and diastolic BP, respectively. Agreement between mean BP greater than the 95th percentile and 30% BP load is only moderate to good. Maximum agreement between mean BP greater than the 95th percentile and BP load is achieved at 50% BP load.     

Worldwide supply of blood and blood products

Blood services have achieved a high degree of sophistication, but there remain serious logistic problems which interfere with the adequacy of blood supplies. Many countries have not been able to implement modern component therapy. Supplies of certain specialized products, such as factor VIII, are insufficient almost everywhere. There is a lively international trade in blood products, and corresponding evidence of disease transmission when the rate of infection is relatively high in the exporting region. The answer to these problems lies in the development everywhere of effective blood programs, based on the organization of nonremunerated blood donors.

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Resumen Los servicios de banco de sangre han alcanzado un alto grado de sofisticación, pero hay todavía serios problemas logísticos que interfieren con la debida provisión. Muchos países no han logrado organizar programas de terapia con componentes sangurneos. La provisión de ciertos productos especializados, tales como el factor VIII, es insuficiente casi en todas partes. Existe un activo comercio internacional de productos sanguíneos con la correspondiente evidencia de transmisión de enfermedades cuando la tasa de infección es relativamente alta en la región exportadora. La respuesta a estos problemas recae en el desarrollo universal de programas efectivos de banco de sangre basados en la organización de donantes no remunerados.

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Résumé Les services de transfusion sanguine ont atteint un haut degré d'organisation mais des problèmes logistiques persistent en particulier en ce qui concerne les sources de sang. Dans de nombreux pays il n'a pas été possible de mettre en oeuvre l'emploi de constituants isolés du sang. L'approvisionnement en certaints produits spécialisés tels que le facteur VIII est insuffisant presque dans le monde entier. Il existe par ailleurs un actif commerce international de produits sanguins avec pour conséquence la transmission possible de maladies, lorsque le taux de l'infection est relativement élevé dans le pays exportateur. La réponse adéquate à ces problèmes consiste dans le développement dans chaque pays d'un programme autonome basé sur le recrutement de donneurs volontaires non rémunérés.