限制性输血策略对膝关节置换术患者预后状况的影响研究

目的探讨限制性输血策略对膝关节置换术患者预后状况的影响。方法选择2017年1月至2018年1月期间本院骨科住院部收治的择期行膝关节置换术患者142例作为研究对象。根据不同的输血策略将患者分为限制性输血组和开放性输血组,各71例。限制性输血组当Hct<30%,Hb<70 g/L时进行红细胞输注,维持70 g/L≤Hb<100 g/L;开放性输血组当Hct<30%,Hb<100 g/L时进行红细胞输注,维持100 g/L≤Hb<120 g/L。比较临床指标(输血率、输血前后Hb水平,平均输血量和住院时间)、输血反应、术后并发症、死亡率、膝关节功能和生活质量的差异。参照美国特种外科医院(Hospital for Special Surgery,HSS)评分标准评定膝关节功能,参照美国波士顿健康研究所制定的健康调查表(SF-36)评定生活质量。结果限制性输血组输血率为7.04%,明显低于开放性输血组的30.99%,P<0.05,限制性输血组输血前后Hb明显低于开放性输血组,平均输血量明显少于开放性输血组,住院时间明显短于开放性输血组,P<0.05。两组输血后Hb水平较输血前明显增高,P<0.05。限制性输血组输血反应发生率明显低于开放性输血组,P<0.05。两组术后并发症发生率和死亡率比较差异无统计学意义(P>0.05)。限制性输血组HSS评分和SF-36评分明显高于开放性输血组,P<0.05。结论限制性输血策略有利于明显降低膝关节置换术患者输血率,减少输血量,降低输血反应,缩短住院时间,改善膝关节功能,进而提高生活质量。

Effect on prognosis of restrictive transfusion strategy for patients undergoing knee replacement

Objective To investigate the effect on prognosis of restrictive transfusion strategy for patients undergoing knee replacement.Methods 142 patients who underwent knee replacement from January 2017 to January 2018 were selected as subjects.According to different transfusion strategies,the patients were divided into restricted transfusion group and open transfusion group,71 cases in each.In the restricted transfusion group,red blood cell transfusion was performed when Hct<30% and Hb<70 g/L,and maintained at 70 g/L≤Hb<100 g/L.In the open transfusion group,red blood cell transfusion was performed when Hct<30% and Hb<100 g/L,and maintained at 100 g/L≤Hb<120 g/L.The clinical indicators( transfusion rate,Hb level pre/posttransfusion,average transfusion volume and hospital),transfusion response, postoperative complications, mortality, knee function and life quality were compared.Knee function was evaluated according to standard of Hospital for Special Surgery( HSS),and life quality was evaluated according to the health questionnaire( SF-36) by Boston Health Research Institute. Results The blood transfusion rate in the restricted transfusion group was 7.04%,which was significantly lower than 30.99% in the open transfusion group,P<0.05.The Hb pre-post-transfusion in the restricted transfusion group was significantly lower than that in the open transfusion group,the average blood transfusion volume was significantly lower than that in the open transfusion group,and the hospital stay-length was significantly shorter than that in the open transfusion group,P < 0.05. Hb of post-transfusion in the two groups were higher than that of pre-transfusion,P<0.05.The incidence of transfusion reaction in restricted transfusion group was significantly lower than that in open transfusion group( P<0.05).There was no significant difference in postoperative complications and mortality between the two groups( P> 0.05). HSS score and SF-36 score in restricted transfusion group was significantly higher than that in open transfusion group( P < 0.05). Conclusion Restrictive transfusion strategy can significantly reduce the rate of blood transfusion,reduce blood transfusion volume,reduce blood transfusion response,shorten hospital stay-length,improve knee function and life quality in patients with knee replacement.