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.

POST-ANESTHETIC AUTOLOGOUS BLOOD DONATION USED IN KNEE AND HIP ARTHROPLASTY

Objective To explore the clinical application of the postanesthetic autologus donation and the post-operative transfusion during the knee and hip replacement surgeries. Methods Thirty-three patients (17 males,16 females) admitted for the elective joint replacement surgeries from September 2004 to January 2005 were included in this study. Of the 33 patients, 5 were diagnosed with rheumatoid arthritis, 23 with femoral head necrosis, and 5 with knee osteoarthritis. Immediately after anesthesia, 400 ml of the blood was drawn and transfused after the surgery. The blood pressure was monitored during the blood drawing, postoperative blood parameters were recorded, surgical site drainage and signs of infections were observed, and the other clinical data were collected. Results Of the 33 patients, 27 only received autologous transfusion, including 21 patients who underwent the unilateral hip replacement and 6 patients who underwent the unilateral knee replacement. All these 6 patients with the unilateral knee replacement received the blood drained from the surgical sites in addition to the blood obtained from the post-anesthetic autologous donation. Another 6 cases with the bilateral hip and knee replacement received the blood drained from the surgical sites, the blood obtained from the post-anesthetic autologous donation and 400 ml of the allogeneic blood transfusion. The blood received postoperatively averaged 650 ml (range, 200- 1 150 ml), haemoglobin(Hb) was averaged 88 g/L (68-102 g/L), and Hct was averaged 24.6% (20.5%-31.5%). Hb and Hct were lower after operation than before operation(P<0.01). Conclusion Postoperative blood transfusion following the postanesthetic and preoperative autologous donation can be successfully applied to most of the patients undergoing the knee or hip replacement so as to reduce complications of the allogeneic blood transfusion.