Lee Qunn-Jid, Mak Wai-Ping, Yeung Sze-Tsun, Wong Yiu-Chung, Wai Yuk-Leung
Joint Replacement Center, Yan Chai Hospital, Tsuen Wan, Hong Kong.
J Orthop Surg (Hong Kong). 2015 Apr;23(1):66-70. doi: 10.1177/230949901502300116.
To compare outcomes of 2 cohorts of patients who underwent total knee arthroplasty (TKA) before and after the introduction of a blood management protocol.
Records of 97 and 96 consecutive patients who underwent unilateral TKA before and after introduction of the blood management protocol, respectively, were reviewed. Before introduction of the protocol, patients were cross-matched for blood before surgery. Transfusion after surgery was at the discretion of the surgeons or the on-call doctors. After introduction of the protocol, only patients with a preoperative haemoglobin level of <110 g/l underwent 'type and screening' of blood group. 2 units of blood were cross-matched preoperatively when multiple red-cell antibodies were identified or postoperatively when blood transfusion was required. Only patients with a postoperative haemoglobin level of <80 g/l or being symptomatic received blood transfusion until the haemoglobin level reached >100 g/l. Those with a postoperative haemoglobin level of 80 to 100 g/l were given iron sulphate 300 mg twice daily for a month.
The 2 groups did not differ significantly in age, sex ratio, pre- and post-operative haemoglobin levels, and drain output. Comparing outcome before and after introduction of the protocol, the transfusion rate (10.3% vs. 3.1%, p=0.046), crossmatch rate (100% vs. 3.1%, p<0.001), and crossmatch to transfusion ratio (9.7:1 vs. 1:1, p<0.001) decreased. Among transfused patients, the decreased postoperative haemoglobin level indicated a lower transfusion trigger point (100 g/l vs. 75 g/l, p<0.006) No patient developed infection, cardiovascular or cerebrovascular complications within 30 days.
The blood management protocol for TKA is effective in reducing unnecessary allogeneic blood transfusions and wastage of unused blood, without an increase in postoperative complications.
比较在引入血液管理方案前后接受全膝关节置换术（TKA）的两组患者的治疗结果。
回顾了分别在引入血液管理方案前后连续接受单侧TKA的97例和96例患者的记录。在引入该方案之前，患者在手术前进行血型交叉配血。术后输血由外科医生或值班医生决定。引入该方案后，仅术前血红蛋白水平<110 g/L的患者进行血型“鉴定和筛查”。当鉴定出多种红细胞抗体时，术前交叉配血2单位；当需要输血时，术后交叉配血2单位。只有术后血红蛋白水平<80 g/L或出现症状的患者才接受输血，直至血红蛋白水平达到>100 g/L。术后血红蛋白水平为80至100 g/L的患者，每天两次服用300 mg硫酸亚铁，持续一个月。
两组在年龄、性别比例、术前和术后血红蛋白水平以及引流量方面无显著差异。比较引入该方案前后的结果，输血率（10.3%对3.1%，p = 0.046）、交叉配血率（100%对3.1%，p<0.001）和交叉配血与输血比例（9.7:1对1:1，p<0.001）均降低。在输血患者中，术后血红蛋白水平下降表明输血触发点较低（100 g/L对75 g/L，p<0.006）。30天内无患者发生感染、心血管或脑血管并发症。
TKA的血液管理方案可有效减少不必要的异体输血和未使用血液的浪费，且不增加术后并发症。
