多模式血液管理措施下血友病关节炎与股骨头坏死初次全髋关节置换术围术期失血风险比较: 回顾性队列研究

陈波; 徐溢明; 彭慧明; 冯宾; 刘冠墨; 王雪晴; 翁习生

doi:10.12290/xhyxzz.2023-0009

多模式血液管理措施下血友病关节炎与股骨头坏死初次全髋关节置换术围术期失血风险比较: 回顾性队列研究

Comparison of the Risk of Perioperative Blood Loss in Hemophilic Arthritis and Initial Total Hip Arthroplasty for Femoral Head Necrosis under Multimodal Blood Management Measures: A Retrospective Cohort Study

摘要

摘要:
目的以股骨头坏死(osteonecrosis of the femoral head, ONFH)患者为参照, 探究在多模式血液管理措施下, 行单侧全髋关节置换术(total hip arthroplasty, THA)的血友病关节炎(hemophilia arthritis, HA)患者围术期失血及异体输血风险。
方法回顾性收集2010年1月至2022年6月于北京协和医院接受单侧THA治疗的HA患者及按性别进行1:3匹配的ONFH患者临床资料, 比较两组围术期失血相关指标及并发症发生率差异。
结果共入选符合纳入与排除标准的HA患者26例, ONFH患者76例。相较于ONFH患者, HA患者总失血量(1927.08±956.59) mL比(1475.88±924.43) mL, P=0.036、大出血率(38.46%比14.47%, P=0.009)、异体输血率(15.38%比3.95%, P=0.046)、并发症发生率(34.62%比7.89%, P=0.000)均更高, 术后第3天血红蛋白(112.94±12.26) g/L比(117.40±11.17) g/L, P=0.000、红细胞压积(29.44±7.96)%比(32.80±5.52)%, P=0.019水平均更低。
结论在多模式血液管理措施下, 行单侧THA治疗的HA患者围术期失血及异体输血风险仍较高, 需进一步优化血液管理策略。

Abstract:
Objective To compare the perioperative blood loss and risk of allogeneic transfusion between hemophilia arthritis (HA) patients and osteonecrosis of the femoral head (ONFH) patients undergoing unilateral total hip arthroplasty (THA) under multimodal blood management measures.
Methods Clinical data of HA patients treated with unilateral THA from January 2010 to June 2022 and ONFH patients matched 1:3 by gender were retrospectively collected at Peking Union Medical College Hospital, and the differences in indicators related to perioperative blood loss and complication rates were compared between the two groups.
Results A total of 26 patients with HA and 76 patients with ONFH who met the inclusion and exclusion criteria were enrolled.Compared with ONFH patients, the total blood loss(1927.08±956.59) mL vs.(1475.88±924.43) mL, P=0.036, major bleeding rate (38.46%vs. 14.47%, P=0.009), allogeneic transfusion rate (15.38%vs. 3.95%, P=0.046), and complication rate (34.62%vs. 7.89%, P=0.000) in HA patients were higher, and postoperative day 3 hemoglobin(112.94±12.26) g/L vs.(117.40±11.17) g/L, P=0.000and hematocrit(29.44±7.96)%vs.(32.80±5.52)%, P=0.019were lower.
Conclusion The risk of perioperative blood loss and allogeneic transfusion is higher in HA patients treated with unilateral THA than in ONFH-THA patients, and further optimization of blood management strategies is needed.

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