Kourtzis Nikolaos, Pafilas Dimitrios, Kasimatis Georgios
Department of Orthopedics, General Prefectural Hospital of Aegion, Ano Voulomeno, 25 100 Aegion, Greece.
Am J Surg. 2004 Feb;187(2):261-7. doi: 10.1016/j.amjsurg.2003.11.022.
To eliminate the need for allogeneic blood transfusion in patients undergoing elective total knee arthroplasty, we established and tried a protocol of combined methods, which is characterized by effectiveness, ease in application, and safety. It is based on perioperative administration of human recombinant erythropoietin plus iron and folic acid, mild acute normovolemic hemodilution, meticulous surgical technique, postoperative blood salvage through a closed-wound drainage system, and lower transfusion triggers.
Sixty-one patients entered the protocol, and the results were retrospectively compared with the ones obtained from 58 consecutive patients who were operated on in the past before the use of any blood saving technique.
Only 5 patients of those who entered the protocol finally needed allogeneic blood transfusion, receiving a total number of 7 units, which is remarkable when compared with the 50 patients before the application of the protocol who required 111 units. Consequently, the utilization of allogeneic blood was reduced by 94%, a statistically quite significant result (P <0,001). We believe the protocol should be included in orthopedic surgeons' alternatives for blood saving in elective total knee arthroplasty.
为消除择期全膝关节置换术患者对异体输血的需求，我们制定并尝试了一种联合方法方案，该方案具有有效性、易于应用和安全性的特点。它基于围手术期给予重组人促红细胞生成素加铁和叶酸、轻度急性等容血液稀释、精细的手术技术、通过闭合伤口引流系统进行术后血液回收以及较低的输血触发阈值。
61例患者进入该方案，并将结果与过去在未使用任何血液节约技术时连续手术的58例患者的结果进行回顾性比较。
进入该方案的患者中只有5例最终需要异体输血，共接受7单位，与方案应用前50例需要111单位的患者相比，这一结果非常显著。因此，异体血的使用减少了94%，这一结果具有统计学意义（P<0.001）。我们认为该方案应纳入骨科医生在择期全膝关节置换术中节约用血的选择方案中。
