自体血液回输对髋关节置换术围术期凝血功能的影响
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摘要
目的探讨自体血液回输在老年患者全髋关节置换术中对凝血功能的影响,为围术期选择合理的血液制品提供依据。方法选取2016年1-12月在该院择期行全髋关节置换手术的老年患者40例,美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级,采用随机数字表法分为观察组和对照组,观察组为自体血液回输组,对照组为异体输血组,每组20例。观察组术中应用血细胞回输仪进行血液收集、回输,两组均于输血前(T0)、输血后1h(T1)、关节置换后2h(T2)3个时点采集静脉血,采用血栓弹力图(TEG)测定纤维蛋白原形成时间(R)、血凝块生成时间(K)、最大振幅(MA)、凝血综合指数(CI)水平。结果观察组在T2时间,与T0相比,K延长(P<0.05)。对照组完成关节置换后2h较术前比较,TEG各指标差异无统计学意义(P>0.05);观察组在T2时间点K比对照组延长(P<0.05),但观察组在T1、T2时刻测得的TEG参数均在正常范围内。结论患者术前、术中及术后血液呈不同程度高凝状态,采用自体血液回输虽然对凝血功能有一定影响,但在正常范围内,可减轻患者高凝状态。
Objective To assess the perioperative coagulation function of autotransfusion in patients undergoing hip replacement.Methods Forty gerontal patients with hip replacement which ASA class asⅡ-Ⅲin our nosipital,were randomly divided into two groups(n=20 each):the autotransfusion group(the experimental group)and the allogeneic transfusion group(the control group).Blood collection and transfusion were performed by hematopoiesis apparatus in the experimental group.Blood samples were collected for coagulation function test at the following time points:before transfusion(T0),1 hafter transfusion(T1),2 hafter hip replacement(T2).Thromboelaslography(TEG)was used to measure the level of fibrinogen formation time(R),blood clot formation time(K),maximum amplitude(MA)and coagulation composite index(CI)at T0,T1 and T2.Results In the experimental group,the K was prolonged at T2,with significant difference compared to T0(P<0.05).In the control group,the TEG paramaters at T2 have no statistics significance compared to T0(P>0.05).The K at T2 in the experimental group was significantly prolonged compared with the control group(P<0.05).The TEG parameters measured in the experimental group at T1 and T2 were all in the normal range.Conclusion Preoperative,intraoperative and postoperative blood of the patients showed different degrees of hypercoagulation.Autotransfusion can prolong the K,but the K was still in a normal range which alleviated the hypercoagulation in patients undergoing hip replacement.
Objective To assess the perioperative coagulation function of autotransfusion in patients undergoing hip replacement.Methods Forty gerontal patients with hip replacement which ASA class asⅡ-Ⅲin our nosipital,were randomly divided into two groups(n=20 each):the autotransfusion group(the experimental group)and the allogeneic transfusion group(the control group).Blood collection and transfusion were performed by hematopoiesis apparatus in the experimental group.Blood samples were collected for coagulation function test at the following time points:before transfusion(T0),1 hafter transfusion(T1),2 hafter hip replacement(T2).Thromboelaslography(TEG)was used to measure the level of fibrinogen formation time(R),blood clot formation time(K),maximum amplitude(MA)and coagulation composite index(CI)at T0,T1 and T2.Results In the experimental group,the K was prolonged at T2,with significant difference compared to T0(P<0.05).In the control group,the TEG paramaters at T2 have no statistics significance compared to T0(P>0.05).The K at T2 in the experimental group was significantly prolonged compared with the control group(P<0.05).The TEG parameters measured in the experimental group at T1 and T2 were all in the normal range.Conclusion Preoperative,intraoperative and postoperative blood of the patients showed different degrees of hypercoagulation.Autotransfusion can prolong the K,but the K was still in a normal range which alleviated the hypercoagulation in patients undergoing hip replacement.
引文
[1]施耀华,张曦,伏治国.氨甲环酸减少初次全髋关节置换术失血量的疗效研究[J].国际骨科学杂志,2018,39(1):59-62.
[2]白瑞,郝兴华.血栓弹力图在临床疾病诊断中的应用[J].实验与检验医学,2018,36(1):42-45.
[3]杨华.自体血回输在产科手术的应用进展探讨[J].中国现代药物应用,2018,12(11):218-219.
[4]许婷,徐广民,牟玲,等.羟乙基淀粉预扩容对髋关节置换术围术期凝血功能的影响[J].四川医学,2011,32(12):1849-1851.
[5]张黄丽,葛衡江.血栓弹力图和D-二聚体在髋关节置换术患者围术期的变化[J].武警医学院学报,2009,18(4):311-314。
[6]叶昌印.自体血液回收机储血罐结构与性能分析[J].医疗卫生装备,2011,32(6):126-128.
[7]BUDDEBERG F,SCHIMMER B B,SPAHN D R.Transfusion-transmissible infections and transfusion-related immunomodulation.[J]Best Pract Res Clin Anaesthesiol,2008,22(3):503-517.
[8]GWAM C U,MISTRY J B,ETCHESON J I,et al.Decline in allogeneic blood transfusion usage in total hip arthroplasty patients:national inpatient sample 2009to 2013[J].Hip Int,2018,28(4):382-390.
[9]赵琳琳,刘凤华.血栓弹力图对危重症患者临床合理用血的指导作用[J].临床血液学杂志(输血与检验),2015,28(2):273-275.
[10]SPIEL A O,MAYR F B,FIRBAS C,et al.Validation of rotation thrombelastography in a model of systemic activation of fibrinolysis and coagulation in humans[J].JThromb Haemost,2006,4(2):411-416.
[11]MALY R,GAL R,CHAMZIN A,et al.Bratisl Lek Listy.Thrombelastography during an acute normovolemic hemodilution in patient undergoing radical retropubic prostatectomy[J].Bratisl Lek Listy,2010,111(9):518-521.
[12]区锦燕,廖荣宗,周曙,等.股骨多段闭合骨折患者术前凝血功能的变化[J].中华麻醉学杂志,2004,24(7):534-536.
[13]区锦燕,吴征杰,周曙,等.股骨骨折患者术前D-二聚体与血栓弹力图相关性研究[J].国际检验医学杂志,2006,27(12):1060-1064.
[14]谢伟坚,黄雄飞,张建荣.自体血液回输在复杂髋臼骨折内固定术中应用[J].现代临床医学生物工程学杂志,2003,9(3):262-265.
[15]张明礼,刘燕.国产自体---2000型血液回收机的临床应用[J].北京大学学报(医学版),1998,30(6):559-561.
[16]陈方祥,刘怀琼,葛衡江,等.体腔血自体回输与凝血纤溶功能的变化[J].中华麻醉学杂志,1998,18(2):82-83.
[2]白瑞,郝兴华.血栓弹力图在临床疾病诊断中的应用[J].实验与检验医学,2018,36(1):42-45.
[3]杨华.自体血回输在产科手术的应用进展探讨[J].中国现代药物应用,2018,12(11):218-219.
[4]许婷,徐广民,牟玲,等.羟乙基淀粉预扩容对髋关节置换术围术期凝血功能的影响[J].四川医学,2011,32(12):1849-1851.
[5]张黄丽,葛衡江.血栓弹力图和D-二聚体在髋关节置换术患者围术期的变化[J].武警医学院学报,2009,18(4):311-314。
[6]叶昌印.自体血液回收机储血罐结构与性能分析[J].医疗卫生装备,2011,32(6):126-128.
[7]BUDDEBERG F,SCHIMMER B B,SPAHN D R.Transfusion-transmissible infections and transfusion-related immunomodulation.[J]Best Pract Res Clin Anaesthesiol,2008,22(3):503-517.
[8]GWAM C U,MISTRY J B,ETCHESON J I,et al.Decline in allogeneic blood transfusion usage in total hip arthroplasty patients:national inpatient sample 2009to 2013[J].Hip Int,2018,28(4):382-390.
[9]赵琳琳,刘凤华.血栓弹力图对危重症患者临床合理用血的指导作用[J].临床血液学杂志(输血与检验),2015,28(2):273-275.
[10]SPIEL A O,MAYR F B,FIRBAS C,et al.Validation of rotation thrombelastography in a model of systemic activation of fibrinolysis and coagulation in humans[J].JThromb Haemost,2006,4(2):411-416.
[11]MALY R,GAL R,CHAMZIN A,et al.Bratisl Lek Listy.Thrombelastography during an acute normovolemic hemodilution in patient undergoing radical retropubic prostatectomy[J].Bratisl Lek Listy,2010,111(9):518-521.
[12]区锦燕,廖荣宗,周曙,等.股骨多段闭合骨折患者术前凝血功能的变化[J].中华麻醉学杂志,2004,24(7):534-536.
[13]区锦燕,吴征杰,周曙,等.股骨骨折患者术前D-二聚体与血栓弹力图相关性研究[J].国际检验医学杂志,2006,27(12):1060-1064.
[14]谢伟坚,黄雄飞,张建荣.自体血液回输在复杂髋臼骨折内固定术中应用[J].现代临床医学生物工程学杂志,2003,9(3):262-265.
[15]张明礼,刘燕.国产自体---2000型血液回收机的临床应用[J].北京大学学报(医学版),1998,30(6):559-561.
[16]陈方祥,刘怀琼,葛衡江,等.体腔血自体回输与凝血纤溶功能的变化[J].中华麻醉学杂志,1998,18(2):82-83.