Nielsen Kamilla, Johansson Pär I, Dahl Benny, Wagner Michael, Frausing Britt, Børglum Jens, Jensen Kenneth, Stürup Jens, Hvolris Jesper, Rasmussen Lars S
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
BMC Anesthesiol. 2014 Oct 10;14:89. doi: 10.1186/1471-2253-14-89. eCollection 2014.
Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision surgery.
The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation was assessed using Timed Up and Go-test (TUG) and ability to walk was also assessed daily by a physiotherapist blinded to the allocation.
Fifty-three patients were able to perform the TUG and included in the analysis. The TUG could be completed in a median of 36 sec vs. 30 sec in the restrictive group and the liberal group, respectively (P = 0.02). The mean difference in TUG was 14.5 sec (95% CI 2.8-26.2 sec). No difference was found in the day patients could perform TUG or walk 10 meters. The Hb at the day of testing was 10.2 g/dL in the restrictive group and 9.9 g/dL in the liberal group. Only 26 patients received RBC.
A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing.
髋关节翻修手术期间可能需要输注红细胞（RBC），但输血的合适血红蛋白浓度（Hb）阈值尚未明确确立。我们假设较高的输血阈值会改善髋关节翻修手术后的步行能力。
该试验在Clinicaltrials.gov（NCT00906295）注册。66例18岁及以上接受髋关节翻修手术的患者被随机分组，分别在Hb阈值为7.3 g/dL（限制性组）或8.9 g/dL（宽松性组）时接受RBC输注。使用计时起立行走测试（TUG）评估术后步行能力，并且由对分组不知情的物理治疗师每天评估步行能力。
53例患者能够完成TUG并纳入分析。限制性组和宽松性组完成TUG的中位数分别为36秒和30秒（P = 0.02）。TUG的平均差异为14.5秒（95%CI 2.8 - 至26.2秒）。患者能够完成TUG或行走10米的天数没有差异。测试当天，限制性组的Hb为10.2 g/dL，宽松性组为9.9 g/dL。仅26例患者接受了RBC输注。
与7.3 g/dL的阈值相比，8.9 g/dL的Hb输血阈值与髋关节翻修手术后TUG在统计学上显著更快相关，但临床重要性存疑，且两组在测试时的Hb无差异。
