急性等容血液稀释在人工关节置换术中的应用

目的评价急性等容血液稀释在人工关节置换术围手术期的治疗效果以及异体血节约程度。方法回顾分析120例初次单侧人工关节置换术患者,对照组60例未进行自体血回输,实验组60例实施自体血回输,对比两组术前以及术后第2天的血红蛋白（Hb）、红细胞压积（Hct）、白蛋白（Alb）水平和术后2 d内录输注红细胞悬液和新鲜冰冻血浆的剂量。结果实验组与对照组在年龄、性别、手术类型间无统计学差异（t年龄=2.123,t性别=2.208,t手术类型=0.138,P均大于0.05）。实验组与对照组的术后Hb、术后Hct、术前Alb间无统计学差异（t术后Hb=-0.233,t术后Hct=0.310,t术前Alb=-1.698,P均大于0.05）。实验组术前Hb（140.58±13.92）g/L、术前Hct（40.43±3.83）高于对照组术前Hb（132.15±14.50）g/L、Hct（37.97±6.19）（t术前Hb=-3.251,t术前Hct=-2.626,P均小于0.05）。实验组术后Alb水平（32.70±2.05）g/L略低于对照组（33.80±3.11）g/L（t术前Alb=-1.698,t术后Alb=2.188,P均小于0.05）。实验组围手术期人均红细胞悬液和新鲜冰冻血浆使用量分别较对照组减少1.77 IU和2.45 IU（P〈0.001）。结论急性等容血液稀释自体血回输治疗在人工关节置换围手术期能够显著降低异体红细胞悬液和新鲜冰冻血浆的用量,同时不影响术后Hb以及Hct的水平。

Application of acute normovolemic hemodilution during joint replacement surgery

Objective To evaluate the effectiveness and extent of blood saving of acute normovolemic hemodilution during the joint replacement surgery.Methods One-hundred and twenty patients undergoing primary unilateral joint replacement surgery were reviewed.Sixty patients in the experimental group were managed with acute normovolemic hemodilution treatment,and the other 60 patients in the control group were treated with allogeneic blood transfusion only if necessary.The preoperative and postoperative levels of haemoglobin,haematocrit,and albumin were compared between the two groups as well as the transfusion amount of erythrocyte suspension and fresh frozen plasma.Results There was no significant difference in age,gender,diagnosis and the type of surgery（total knee arthroplasty and total hip arthroplasty） between the two groups.No difference was found between the two groups in the levels of postoperative haemoglobin,postoperative haematocrit and preoperative albumin.The levels of preoperative haemoglobin and preoperative haematocrit were higher in the experimental group（P〈0.05）.The level of postoperative albumin was higher in the control group.The average transfusion amounts of erythrocyte suspension and fresh frozen plasma in the experimental group were reduced by 1.77 IU and 2.45 IU per person respectively（P〈0.001）.Conclusion The acute normovolemic hemodilution can significantly reduce the amount of allogeneic blood transfusion with the same postoperative haemoglobin level during the total joint replacement surgery.