Cuenca Jorge, García-Erce José A, Martínez Fernando, Cardona Rafael, Pérez-Serrano Luís, Muñoz Manuel
Department of Orthopaedic and Trauma Surgery, University Hospital Miguel Servet, Zaragoza, Spain.
Int J Surg. 2007 Apr;5(2):89-94. doi: 10.1016/j.ijsu.2006.02.003. Epub 2006 Apr 27.
Unilateral total knee replacement (TKR) can result in a substantial blood loss and 30-50% of these patients receive allogeneic blood transfusion (ABT), this transfusion rate may be even higher among anaemic patients.
We assessed the requirements for ABT in 156 consecutive patients undergoing surgery for primary TKR, who received iron ferrous sulphate (256 mg/day; 80 mg of Fe(2+)), vitamin C (1000 mg/day) and folic acid (5mg/day) during the 30-45 days preceding surgery, and who were transfused if Hb <80 g/L and/or clinical signs/symptoms of acute anaemia/hypoxemia (Group 2). A previous series of 156 TKR patients serves as a control group (Group 1).
Compared to those in Group 1, patients in Group 2 presented a lower transfusion rate (5.8% vs. 32%, for Group 2 and Group 1, respectively; p<0.01), and a lower transfusion index (1.78+/-0.44 vs. 2.22+/-0.65 units per transfused patient, respectively; p<0.05). After patient's stratification according to a preoperative Hb above or below 130 g/L, the differences in transfusion rate remained significant, although 19% of patients from Group 2 still needed ABT if their preoperative Hb <130 g/L.
This protocol seems to be effective for avoiding ABT in non-anaemic TKR patients, whereas for anaemic patients another blood saving strategy, such us preoperative erythropoietin administration or postoperative blood salvage, should be added to further increase its effectiveness.
单侧全膝关节置换术（TKR）可导致大量失血，这些患者中有30 - 50%接受异体输血（ABT），贫血患者的输血率可能更高。
我们评估了156例连续接受初次TKR手术患者的ABT需求，这些患者在术前30 - 45天接受硫酸亚铁（256毫克/天；80毫克Fe(2+)）、维生素C（1000毫克/天）和叶酸（5毫克/天）治疗，若血红蛋白<80克/升和/或出现急性贫血/低氧血症的临床体征/症状则进行输血（第2组）。之前的156例TKR患者系列作为对照组（第1组）。
与第1组相比，第2组患者的输血率较低（第2组和第1组分别为5.8%和32%；p<0.01），输血指数也较低（分别为1.78±0.44单位/输血患者和2.22±0.65单位/输血患者；p<0.05）。根据术前血红蛋白高于或低于130克/升对患者进行分层后，输血率的差异仍然显著，尽管第2组中有19%的患者若术前血红蛋白<130克/升仍需要ABT。
该方案似乎对避免非贫血TKR患者的ABT有效，而对于贫血患者，应增加另一种血液节约策略，如术前给予促红细胞生成素或术后血液回收，以进一步提高其有效性。
