摘要
目的探讨人工全髋关节置换术(THA)和人工全膝关节置换术(TKA)术后隐性失血的相关机制及对临床的影响。方法2001年3月至2005年5月,行THA61例,其中男22例,女39例;年龄61～79岁,平均68岁。同期行TKA73例,其中男23例,女50例;年龄65～77岁,平均73岁。所有病例均为初次行单侧关节置换的患者,24h补液总量不超过2000ml。通过Gross方程,根据身高、体重和手术前后的红细胞压积(Hct)计算所有患者的总失血量,减去显性失血部分后即得隐性失血。结果THA组的总失血量平均为1520ml,隐性失血量为482ml(32%);TKA组的总失血量平均为1508ml,隐性失血量为776ml(52%),两组的隐性失血量比较差异有统计学意义(P<0.01)。TKA组中使用引流血回输患者的总失血量平均为1625ml,隐性失血量为774ml(48%);未使用引流血回输患者的总失血量平均为1345ml,隐性失血量为783ml(58%),两组的隐性失血量相比差异无统计学意义;THA与TKA肥胖组和非肥胖组的隐性失血量相比差异均无统计学意义。结论TKA隐性失血远较THA高,且使用引流血回输仍不能完全满足机体恢复体循环的需要,应特别注意及时补充血容量。对隐性失血的正确认识有助于提高临床评估能力,帮助关节置换患者度过围手术期。
Objective To study the correlated mechanisms and clinical effect of hidden hemorrhage after total hip arthroplasty （THA） and total knee arthroplasty （TKA）. Methods From March 2001 to May 2005, 61 patients were treated with THA and 73 patients were treated with TKA. The patients treated with THA involved 22 males and 39 females with an average age of 68 years （range 61-79 years）. The patients treated with TKA involved 23 males and 50 females with an average age of 73 years （range 65-77 years）. All arthroplasties were primary and unilateral, and the 24 h fluid resuscitation was not more than 2000 ml. Using Gross formula, the true total blood loss was calculated depending on height, weight and pre- and post-operation Hct, and the hidden hemorrhage was got by subtracting the visible blood loss from total loss. Results Following THA, the mean total loss was 1520 ml and the hidden hemorrhage 482 ml （32%）. Following TKA, the mean total loss was 1508 ml and the hidden hemorrhage was 776 ml （52%）. The difference of hidden hemorrhage between THA and TKA was significan different（P〈 0.01 ）. Furthermore, with TKA patients divided into subgroups which were re-infused or not, the mean total loss in the re-infused group was 1625 ml and the hidden hemorrhage was 774 ml（48%）. In the group who were not re-infused, the mean total loss was 1345 ml and the hidden hemorrhage was 783 ml（58%）. The difference of hidden hemorrhage was of no significance. Obesity made no difference with either operation. Conclusion The percentage of hidden hemorrhage in TKA is far higher than THA. It＇s very important to supplement the blood volume during TKA peri-operative period, for the insufficience to regain general circulation although using blood re-infusion. It may improve clinic evaluation capabilities to estimate hidden hemorrhage and thus result in better patient care after joint arthroplasty.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第5期323-326,共4页
Chinese Journal of Orthopaedics
关键词
髋关节
膝关节
关节成形术
置换
Hip joint
Knee joint
Arthroplasty, replacement
Blood transfusion
