[髋关节置换手术中术前自体血捐献及围手术期自体输血的曼海姆概念]

Lorentz A, Konermann W, Kellenbenz C, Heine T, Zimmermann G, Segiet W, Jani L

Institut für Anaesthesiologie und Operative Intensivmedizin Fakultät für Klinische Medizin Mannheim, Universität Heidelberg.

Z Orthop Ihre Grenzgeb. 2000 Jul-Aug;138(4):311-7. doi: 10.1055/s-2000-10154.

PURPOSE

To investigate the efficiency of preoperative autologous deposit and intra- and postoperative cell salvage (CS) to reduce homologous transfusion in hip arthroplasty and revision hip arthroplasty.

METHODS

In a retrospective study, the data of 1402 patients scheduled for hip arthroplasty and for revision hip arthroplasty were analysed.

RESULTS

767 women and 635 men, age 62.9 +/- 9.8 years (x +/- s) were included in the study. 1270 were scheduled for hip arthroplasty, 132 for revision hip arthroplasty. Of the autologous donors, 51 patients predeposited four units, 1020 patients three, 204 patients two, 39 patients one unit. 88 patients who had not enrolled in the autologous donation program but received CS served as a control group. Blood loss in autologous donors amounted to 1620 (220-5620) ml in hip arthroplasty and 2830 (950-7910) ml in revision arthroplasty. CS was employed in part of the cases in arthroplasty and in all revision operations. 470 (0-2200) ml and 705 (0-2200) were retransfused. In hip arthroplasty 227 of 1182 patients (19.2%) received homologous blood. Homologous transfusion in patients with coxarthrosis due to acetabular protrusio, avascular necrosis of the femoral head and hip dysplasia showed a trend to higher values. Patients who had donated 3 units and received CS required homologous transfusion in 12.4% of the cases. CS reduced the homolgous transfusion rate significantly if the preoperative hemoglobin concentration was < or = 12 g/dl. A group of autologous donors receiving CS was matched with patients receiving CS only. 12 of 76 (15.8%) vs. 45 of 76 (59.2%) required homologous transfusion. In revision hip arthroplasty 58 of 132 patients (43.9%) required homologous blood.

CONCLUSIONS

Preoperative deposit reduces homologous transfusion requirements considerably in hip surgery. Under the conditions studied CS should be employed in hip arthroplasty in addition to preoperative deposit if the preoperative hemoglobin concentration falls below 12 g/dl. In revision arthroplasty, 4 or more autologous units should be predeposited and CS should be used regularly.

目的

研究术前自体血储存及术中和术后细胞回收（CS）在髋关节置换术和髋关节翻修术中减少异体输血的效果。

方法

在一项回顾性研究中，分析了1402例计划行髋关节置换术和髋关节翻修术患者的数据。

结果

本研究纳入767例女性和635例男性，年龄62.9±9.8岁（x±s）。1270例计划行髋关节置换术，132例计划行髋关节翻修术。在自体供血者中，51例患者术前储存了4单位血液，1020例患者储存了3单位，204例患者储存了2单位，39例患者储存了1单位。88例未参加自体献血计划但接受了CS的患者作为对照组。自体供血者在髋关节置换术中失血量为1620（220 - 5620）ml，在髋关节翻修术中为2830（950 - 7910）ml。部分髋关节置换术病例及所有翻修手术均采用了CS。回输量分别为470（0 - 2200）ml和705（0 - 2200）ml。在髋关节置换术中，1182例患者中有227例（19.2%）接受了异体输血。髋臼前突、股骨头缺血性坏死和髋关节发育不良所致髋关节病患者的异体输血率有升高趋势。储存3单位血液并接受CS的患者中，12.4%的病例需要异体输血。如果术前血红蛋白浓度≤12 g/dl，CS可显著降低异体输血率。一组接受CS的自体供血者与仅接受CS的患者进行匹配。76例中12例（15.8%）与76例中45例（59.2%）需要异体输血。在髋关节翻修术中，132例患者中有58例（43.9%）需要异体输血。