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全膝关节置换术围手术期异体输血率及其影响因素

彭慧明,  翁习生,  翟吉良,  林进,  金今,  钱文伟,  赵丽娟

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文章导航 > 协和医学杂志  > 2014 >  5(2): 135-141
彭慧明, 翁习生, 翟吉良, 林进, 金今, 钱文伟, 赵丽娟. 全膝关节置换术围手术期异体输血率及其影响因素[J]. 协和医学杂志, 2014, 5(2): 135-141. doi: 10.3969/j.issn.1674-9081.2014.02.002
引用本文: 彭慧明, 翁习生, 翟吉良, 林进, 金今, 钱文伟, 赵丽娟. 全膝关节置换术围手术期异体输血率及其影响因素[J]. 协和医学杂志, 2014, 5(2): 135-141. doi: 10.3969/j.issn.1674-9081.2014.02.002
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Hui-ming PENG, Xi-sheng WENG, Ji-liang ZHAI, Jin LIN, Jin JIN, Wen-wei QIAN, Li-juan ZHAO. Allogeneic Transfusion Rate and Related Factors in Primary Total Knee Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(2): 135-141. doi: 10.3969/j.issn.1674-9081.2014.02.002
Citation: Hui-ming PENG, Xi-sheng WENG, Ji-liang ZHAI, Jin LIN, Jin JIN, Wen-wei QIAN, Li-juan ZHAO. Allogeneic Transfusion Rate and Related Factors in Primary Total Knee Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(2): 135-141. doi: 10.3969/j.issn.1674-9081.2014.02.002
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全膝关节置换术围手术期异体输血率及其影响因素

doi: 10.3969/j.issn.1674-9081.2014.02.002

  • 中国医学科学院 北京协和医学院 北京协和医院骨科, 北京 100730

基金项目: 

卫生部部属(管)医疗机构临床学科重点项目建设专项资金 2012002005

详细信息
    通讯作者:

    翁习生 电话:010-69152812, E-mail:xshweng@medmail.com.cn

  • 中图分类号: R684;R457.1

Allogeneic Transfusion Rate and Related Factors in Primary Total Knee Arthroplasty

  • Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   目的  调查全膝关节置换术(total knee arthroplasty, TKA)围手术期异体输血率并分析其相关影响因素。  方法  回顾性分析北京协和医院骨科2005年1月至2011年12月临床资料完整的初次TKA患者共1165例, 其中男217例, 女948例; 平均年龄62.4岁(16~92岁)。调查患者围手术期异体输血率。对纳入研究的617例单侧TKA病例的自变量(包括34个影响因素)和因变量(住院期间异体输血)进行统计分析, 用多因素Logistic回归分析确定住院期间异体输血的影响因素。  结果  1165例TKA手术患者总异体输血率为58.2%(678/1165), 平均异体输血量为2.7 U(1~13 U)。其中695例单侧TKA患者异体输血率为40.0%(278/695);470例一期双侧TKA患者异体输血率为85.1%(400/470)。共617例单侧TKA病例进入统计分析, 单因素分析显示患者年龄(P < 0.0001)、术前血红蛋白水平(P < 0.0001)、术前血细胞比容(P < 0.0001)、美国麻醉医师学会(American Society of Anesthesiologists, ASA)评分≥ 3分(P=0.004)、手术时间(P=0.004)和止血带时间(P=0.050)与异体输血呈显著相关; 多因素Logistic回归分析证实异体输血和年龄(P < 0.0001)、术前血红蛋白水平(P < 0.0001)、手术时间(P < 0.0001)之间呈显著相关。  结论  TKA围手术期异体输血率较高。一期双膝同期置换更需注意术后贫血事件的发生。通过评估患者年龄、血红蛋白水平及手术时间, 有利于预测术后异体输血的需求。
    Abstract:   Objective  To evaluate the transfusion rates and identify perioperative factors associated with allogeneic blood transfusion (AllTx) after primary total knee arthroplasty (TKA) with routine use of low-molecular-weight heparins.  Methods  We retrospectively studied the transfusion rate of 1165 consecutive patients who underwent primary TKA between January 2005 and December 2011. Totally 34 independent variables were analyzed in 617 primary unilateral TKAs without autologous blood predonation for requirement of AllTx. Multiple regression analysis model was used to identify risk factors associated with perioperative blood transfusion.  Results  Overall, 58.2%(678/1165) of patients required AllTx. The median number of units transfused was 2.7 U (range:1 to 13 U). The AllTx rate was 40.0% (278/695) in unilateral TKA procedures and 85.1% (400/470) in one-stage bilateral TKA procedures. Univariate analysis demonstrated the risk of transfusion was independentlypredicted by the patients' age at surgery (P < 0.0001), preoperative hematocrit(P < 0.0001), preoperative hemoglobin concentration (P < 0.0001), American Society of Anesthesiologists (ASA) score ≥ 3 (P=0.004), surgical time (P=0.004), and tourniquet time (P=0.050). Multivariate Logistic regression analysis confirmed significant relationship between allogeneic blood transfusion and age (P < 0.0001), preoperative hemoglobin(P < 0.0001), and surgical time (P < 0.0001).  Conclusions  AllTx rate is high in TKA procedures, especially in one-stage bilateral TKA procedures. Patient's age, preoperative hemoglobin level, and surgical time are helpful in identifying high-risk patients who require postoperative blood transfusion.
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  • 表  1  全膝关节置换术异体输血各相关参数的单因素方差分析结果[( $ \overline x \pm s $)/例(%)]

    变量 非异体输血(n=374) 异体输血(n=243) P值
    年龄(岁) 67.01±9.95 (16~92) 72.46±10.13(35~90) < 0.0001
    性别 0.745
        女 293(78.5%) 184(76.1%)
        男 81(21.5%) 59(23.9%)
    BMI(kg/m2) 31.95±6.49(16.5~62.6) 30.42±6.81(16.5~50.6) 0.062
    身高(cm) 163.10±10.05(131.6~198.1) 164.90±11.82(134.0~218.4) 0.200
    体重(kg) 85.10±18.93(40.8~156.5) 82.68±19.70(42.2~149.7) 0.312
    诊断 0.389
        OA 328(87.7%) 203(83.5%)
        RA 32(18.5%) 27(11.1%)
        其他 14(6.4%) 13(5.3%)
    合并症
        高血压 257(68.6%) 174(73.2%) 0.507
        冠心病 42(11.3%) 28(11.7%) 0.066
        糖尿病 71(19.0%) 68(28.2%) 0.097
        出血性疾病 4(1.0%) 8(2.3%) 0.721
        贫血 8(2.1%) 5(2.0%) 0.006
        慢性阻塞性肺疾病 18(4.8%) 10(4.2%) 0.896
    术前用药
        肝素 2(0.5%) 0(0) 1.000
        华法林 27(7.2%) 17(7.0%) 0.574
        阿司匹林 104(28.4%) 68(28.2%) 1.000
        氯吡格雷 14(3.8%) 7(2.8%) 0.923
        NSAIDs 88(23.6%) 47(19.7%) 0.565
        糖皮质激素 35(9.4%) 27(11.3%) 0.777
        利尿剂 32(8.7%) 23(9.4%) 1.000
        铁剂 19(5.1%) 15(6.3%) 0.164
    ASA评分
        2~3 278(74.3%) 145(59.5%) 0.622
        ≥3 96(25.7%) 98(40.5%) 0.004
    术前化验
        PT(s) 13.74±1.85(9.9~30.7) 14.23±2.90(9.7~32.9) 0.177
        INR 1.07±0.59(0.9~10.7) 1.08±0.30(0.8~ 3.2) 0.913
        APTT(s) 29.44±4.15(20 ~52.2) 29.74±4.34(21.9~43.9) 0.569
        Hgb(g/L) 127.10±14.00(87 ~187) 115.00±15.20(76~142) < 0.0001
        Hct(%) 38.80±3.89(26.8~56.1) 35.57±1.52(24.5~43.7) < 0.0001
        Plt(×109/L) 248.00±71.32(65 ~623) 243.50±77.76(90~517) 0.616
    主刀医生 0.730
        A 122(32.6%) 78(32.3%)
        B 48(12.8%) 32(13.5%)
        C 93(24.8%) 42(16.9%)
        D 111(29.0%) 91(37.3%)
    麻醉方式 0.969
        CEA 319(85.5%) 205(84.5%)
        GA 26(7.2%) 21(8.5%)
        RB 25(6.8%) 17(7.0%)
        联合 1(0.2%) 0(0)
    手术时间(min) 109.10±25.70(65~315) 123.60±40.51(76~270) 0.004
    止血带时间(min) 79.58±25.19(17~125) 95.89±28.13(65~180) 0.050
    引流放置 0.441
        有 246(66.0%) 207(60.6%)
        无 127(34.0%) 95(39.4%)
    BMI:体重指数；OA：骨关节炎；RA：类风湿关节炎；NSAIDs：非甾体抗炎药；ASA：美国麻醉医师学会；PT：凝血酶原时间；INR：国际标准化比值；APTT：活化部分凝血活酶时间；Hgb：血红蛋白；Hct：血细胞比容；Plt：血小板计数；CEA：连续硬膜外麻醉；GA：全身麻醉；RB：区域阻滞麻醉；联合：全身麻醉联合区域阻滞麻醉
    下载: 导出CSV

    表  2  全膝关节置换术患者住院期间异体输血率和影响因素的Logistic回归分析结果

    影响因素 Bi SE Wald P OR 95%可信区间
    年龄 0.017 0.0008 3.993 < 0.0001 1.06 1.03 ~1.09
    术前血红
    蛋白    		 -0.801 1.429 0.314 < 0.0001 0.565 0.027~2.380
    手术时间 0.010 0.004 5.314 < 0.0001 1.015 1.0152~1.0153
    下载: 导出CSV
    • 参考文献(23)
  • [1] Mylod Jr AG, France MP, Muser DE, et al. Perioperative blood loss associated with total knee arthroplasty. A comparison of procedures performed with and without cementing[J]. J Bone Joint Surg Am, 1990, 72:1010-1012. doi:  10.2106/00004623-199072070-00008
    [2] Knight JL, Sherer D, Guo J. Blood transfusion strategies for total knee arthroplasty:minimizing autologous blood wastage, risk of homologous blood transfusion, and transfusion cost[J]. J Arthroplasty, 1998, 13:70-76. doi:  10.1016/S0883-5403(98)90077-8
    [3] Maslovitz S, Barkai G, Lessing JB, et al. Improved accuracy of post partum blood loss estimation as assessed by simulation[J]. Acta Obstet Gynecol Scand, 2008, 87:929-934. doi:  10.1080/00016340802317794
    [4] Shaw A, Lewis RB. Methods of measuring blood loss during surgery[J]. J Med Eng Technol, 1981, 5:196-197. doi:  10.3109/03091908109064288
    [5] Tebruegge M, Misra I, Pantazidou A, et al. Estimating blood loss:comparative study of the accuracy of parents and health care professionals[J].Pediatrics, 2009, 124:e729-e736. doi:  10.1542/peds.2009-0592
    [6] Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss in to account[J].J Bone Joint Surg Br, 2004, 86:561-565. doi:  10.2106/00004623-200403000-00015
    [7] Bong MR, Patel V, Chang E, et al. Risks associated with Blood transfusion after total knee arthroplasty[J].J Arthroplasty, 2004, 19:281-287. doi:  10.1016/j.arth.2003.10.013
    [8] Bierbaum BE, Callaghan JJ, Galante JO, et al. Ananalysis of blood management in patients having a total hip or knee arthroplasty[J]. J Bone Joint Surg Am, 1999, 81:2-10. doi:  10.2106/00004623-199901000-00002
    [9] Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglob in European Overview(OSTHEO)study:blood management in elective knee and hip arthroplasty in Europe[J].Transfusion, 2003, 43:459-469. doi:  10.1046/j.1537-2995.2003.00348.x
    [10] Noticewala MS, Nyce JD, Wang W, et al. Predicting need for allogeneic transfusion after total knee arthroplasty[J].J Arthroplasty, 2012, 27:961-967. doi:  10.1016/j.arth.2011.10.008
    [11] Parvizi J, Chaudhry S, Rasouli MR, et al.Who needs autologous blood donation in joint replacement?[J]. J Knee Surg, 2011, 24:25-31. doi:  10.1055/s-0031-1275404
    [12] 苗兵, 毕晓扬, 任凯晶, 等.氨甲环酸对全膝关节置换术围手术期失血量的影响及安全性评估[J].中华骨科杂志, 2009, 29:864-867. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhgkzz98200909013
    [13] 鞠洪斌, 覃健, 余存泰, 等.全膝置换患者围手术期输血原因分析[J].中国现代手术学杂志, 2007, 11:50-52. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgxdssxzz200701017
    [14] 曹学伟, 杨伟毅, 梁比记, 等.不同止血带使用方法对TKA围手术期失血量影响的临床研究[J].中国骨与关节外科, 2011, 4:455-459. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zggygjwk201106005
    [15] Bould M, Freeman BJ, Pullyblank A, et al. Blood loss in sequential bilateral total knee arthroplasty[J]. J Arthroplasty, 1998, 13:77-79. doi:  10.1016/S0883-5403(98)90078-X
    [16] Lane GJ, Hozack WJ, Shah S, et al. Simultaneous bilateral versus unilateral total knee arthroplasty. Outcomes analysis[J]. Clin Orthop Relat Res, 1997, (345):106-112. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=558bfb531b485b3a0786134da69952f0
    [17] Etchason J, Petz L, Keeler E, et al. The cost effectiveness of preoperative autologous blood donations[J]. N Engl J Med, 1995, 332:719-724. doi:  10.1056/NEJM199503163321106
    [18] Tellisi N, Kakwani R, Hulse N, et al.Autologous blood transfusion following total knee arthroplasty:is it always necessary?[J]. Int Orthop, 2006, 30:412-414. doi:  10.1007/s00264-006-0109-8
    [19] Mauerhan DR, Nussman D, Mokris JG, et al.Effect of postoperative reinfusion systems on hemoglobin levels in primary total hip and total knee arthroplasties. A prospective randomized study[J]. J Arthroplasty, 1993, 8:523-527. doi:  10.1016/S0883-5403(06)80218-4
    [20] Grønborg H, Otte KS, Jensen TT, et al.Survival of autotransfused red cells. 51Cr studies in 10 knee arthroplasty patients[J]. Acta Orthop Scand, 1996, 67:439-442. doi:  10.3109/17453679608996664
    [21] 黄志峰, 翁习生, 林进, 等.人工膝关节表面置换术后自体引流血回输的效用[J].实用骨科杂志, 2007, 13:385-387. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=sygkzz200707001
    [22] Bernasek TL, Burris RB, Fujii H, et al.Effect on blood loss and cost-effectiveness of pain cocktails, platelet-rich plasma, or fibrin sealant after total knee arthroplasty[J]. J Arthroplasty, 2012, 27:1448-1451. doi:  10.1016/j.arth.2012.02.018
    [23] Yang ZG, Chen WP, Wu LD.Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis[J]. J Bone Joint Surg Am, 2012, 94:1153-1159. doi:  10.2106/JBJS.K.00873
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