Oberhofer Dagmar, Sakić Kata, Janković Sasa, Tonković Dinko, Vrgoc Goran
Klinika za anesteziologiju, reanimatologiju i intenzivno lijecenje, Medicinski fakultet Sveucilista u Osijeku, KB Sveti Duh.
Lijec Vjesn. 2012 Nov-Dec;134(11-12):322-7.
Total hip and knee arthroplasty is associated with significant perioperative blood loss, necessitating often blood transfusions. Because of risks and cost of allogenic blood transfusion and elective types of surgery several alternative methods have been developed to reduce allogenic blood use. We prospectively audited 65 consecutive patients undergoing primary total hip (THR; n = 30) or knee replacement (TKR; n = 35) at our Department of Orthopaedic Surgery which did not use autologous blood collection methods. Total blood loss in THR (1329.7 +/- 364.8 ml) and TKR (1427.3 +/- 660.4 ml) was similar to previously reported and without significant difference between the groups. However, we reported high transfusion rates with 63.3% of THR and 82.6% of TKR patients receiving allogenic blood. Important steps to reduce allogenic blood use would include implementation of restrictive transfusion protocols with a defined hemoglobin value as a transfusion trigger, correction of preoperative anemia with i.v. iron +/- erythropoietin, use of one or more modalities of autologous transfusion (postoperative autotransfusion, preoperative blood donation), pharmacological agents like tranexamic acid (anti-fibrinolytic) and other complementary procedures. There is sufficient evidence in literature about the cost-benefit of certain methods which makes routine use of allogenic blood in THR and TKR surgery unacceptable even at general orthopaedic surgery departments.
全髋关节和膝关节置换术常伴有大量围手术期失血，因此往往需要输血。由于异体输血的风险和成本以及手术的选择性，人们开发了几种替代方法以减少异体血的使用。我们前瞻性地审核了在我院骨科连续接受初次全髋关节置换术（THR；n = 30）或膝关节置换术（TKR；n = 35）的65例患者，这些患者未采用自体血采集方法。THR组（1329.7 +/- 364.8 ml）和TKR组（1427.3 +/- 660.4 ml）的总失血量与先前报道相似，两组之间无显著差异。然而，我们报告了较高的输血率，63.3%的THR患者和82.6%的TKR患者接受了异体血输血。减少异体血使用的重要措施包括实施限制性输血方案，以确定的血红蛋白值作为输血触发指标，通过静脉注射铁剂+/-促红细胞生成素来纠正术前贫血，采用一种或多种自体输血方式（术后自体输血、术前献血），使用氨甲环酸（抗纤溶药物）等药物以及其他辅助措施。文献中有足够的证据表明某些方法的成本效益，这使得即使在普通骨科手术科室，在THR和TKR手术中常规使用异体血也是不可接受的。
