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。

Autologous Blood Transfusion Used in Knee and Hip Arthroplasties

Objective Blood transfusion is often needed in knee and hip replacements. Autologousblood transfusion is now being widely used because of the complications and untoward reactions of allogenicblood trandusion. Methods Since 1991, 433 patients undergoing knee or hip arthroplasties in this centrehave received autologous blood transfusion. The patients can be divided into three groups: The first group hadpreoperative storage and transfusion of autologous blood during the operation. The second group had reinfusionof shed blood after arthroplasty, and third had both. Results In the group of preoperative storage and au-to-donation, 69% of the patients (258/374) passed perioperative period successfully without allogenic bloodtransfusion, including 93. 4% (241/258) unilateral and 6. 6% (17/258) bilateral or ipsilateral arthroplas-ties. While in the other two groups, the results were 36% (5/14) and 75.6% (34/45) respectively. Con-clusions Preoperative selfdonation together with reinfusion of autologous shed blood can avoid the danger ofallogenic blood transfusion in the majority of arthroplasty cases.