人促红素减少老年全膝关节置换术后输血的临床对照研究

目的探讨控制老年患者人工全膝关节置换术（TKA）手术出血量、减少术后同种输血需要量,降低患者输血率的方法。方法选取60例拟行TKA的老年病人,随机分成3组：试验组20例,术后不引流,采用围手术期静注重组人促红素;对照组20例,术后不予引流;常规手术组20例,术后常规留置引流管。比较3组术前、术后1 d、7 d、2周时血红蛋白（Hb）、红细胞比积（Hct）,以及术后并发症和膝关节功能康复情况。实际失血量等于通过手术前后Hct变化计算的理论值加上额外的输血量和自体回输血量。通过观察输血量、用差值来比较术前和术后各观察时间点的Hb动态变化,来评估患者术后同种输血需要量是否减少。结果术后3组切口均Ⅰ期愈合。随访时间12~22月。常规引流组较试验组和对照组术后出血量明显增加;试验组术后Hb减少最少;3组术后膝关节功能无明显差异。结论术后不引流加静注重组人促红素是控制TKA手术出血量、减少术后同种输血需要量的有效方法之一。

Controlled clinical study on the effect of erythropoietin on blood transfusion requirement of the elderly patients undergoing total knee arthroplasty surgery

Objective To investigate the way of controlling blood loss of the elderly patients with total knee arthroplasty（TKA） surgery,reducing the requirement and rate of postoperative blood transfusion. Methods To control the blood loss and reduce postoperative blood transfusion requirement,60 cases of elderly patients who were prepared to undergo TKA were enrolled in this study. They were randomly divided into three groups： 20 cases in experimental group,receiving intravenous injection of rhEPO during perioperative period and not receiving postoperative drainage; 20 cases in control group,not receiving postoperative drainage; 20 cases in conventional group,treated with routine postoperative drainage.The level of hemoglobin（Hb） and hematocrit（Hct） of three groups preoperative were measured and compared 1d,7d and2 w after operation. The postoperative complications and knee function recovery of three groups were also compared. The actual blood loss was equal to the theoretical value calculated by Hct changes before and after operation with additional amount of blood transfusion and the amount of autologous blood transfusion back. By observing the amount of blood transfusion,preoperative and postoperative hemoglobin dynamic change at each observation point,the postoperative blood transfusion requirement was assessed. Results The incisions of all the patients showed primary healing and they were followed up for12 to 22 months. The postoperative blood loss in conventional group was significantly more than that in experimental group and control group,and the reduction of postoperative hemoglobin was least in the experimental group. No significant difference in knee joint function was found between the three groups. Conclusions The intravenous injection of rhEPO may be one of the effective ways to decrease the intraoperative blood loss of the patients undergoing TKA surgery and reduce the requirement of postoperative blood transfusion.