Kaperonis A A, Michelsen C B, Askanazi J, Kinney J M, Chien S
Department of Physiology, Columbia-Presbyterian Medical Center, New York City, NY.
J Trauma. 1988 Apr;28(4):453-7. doi: 10.1097/00005373-198804000-00006.
In order to better understand the pathophysiologic changes in the immediate postoperative period after total hip replacement surgery and to distinguish alterations due to the surgical operation from those due to bed rest, we examined rheologic parameters and red cell metabolism of patients before, 1 day after, and 5 to 6 days after total hip replacement and compared the results to those obtained from normal volunteers placed at bed rest for 5 days. Bed rest in the control group led to increases in hematocrit, mean corpuscular hemoglobin concentration, red cell DPG and ATP levels, and plasma concentrations of total proteins, globulins, and fibrinogen, with attendant increases in whole blood viscosity, plasma viscosity, blood viscosity, relative blood viscosity with hematocrit adjusted to 45%, and viscometric aggregation index, and the viscosity of red cell suspensions in Ringer's solution at 45% hematocrit decreased at low shear rate. The patient group, despite the postoperative lowering of their hematocrit, mean corpuscular hemoglobin concentration, and total plasma proteins and a consequent decrease of whole blood viscosity, revealed disproportionate increases in blood viscosity, relative blood viscosity, and viscometric aggregation index. These rheologic changes, which reflect an enhanced red cell aggregability, may contribute to complications of thrombophlebitis. Enforced inactivity, when superimposed on the effects of trauma, blood loss, transfusion with bank blood, and the low-flow state, would exaggerate these rheologic problems. The results suggest that management of total hip replacement patients should include hemorrheologic considerations (e.g., preoperative intentional hemodilution) and early postoperative activity.
为了更好地了解全髋关节置换术后即刻的病理生理变化，并区分手术操作引起的改变与卧床休息引起的改变，我们检测了全髋关节置换术前、术后1天以及术后5至6天患者的流变学参数和红细胞代谢，并将结果与卧床休息5天的正常志愿者的结果进行比较。对照组的卧床休息导致血细胞比容、平均红细胞血红蛋白浓度、红细胞二磷酸甘油酸（DPG）和三磷酸腺苷（ATP）水平升高，以及血浆总蛋白、球蛋白和纤维蛋白原浓度升高，同时全血黏度、血浆黏度、血液黏度、血细胞比容调整至45%时的相对血液黏度和黏度聚集指数增加，且血细胞比容为45%时林格氏液中红细胞悬液在低剪切速率下的黏度降低。患者组尽管术后血细胞比容、平均红细胞血红蛋白浓度和血浆总蛋白降低，全血黏度随之下降，但血液黏度、相对血液黏度和黏度聚集指数却不成比例地增加。这些反映红细胞聚集性增强的流变学变化可能导致血栓性静脉炎并发症。当强制不活动叠加在创伤、失血、输注库血和低血流状态的影响之上时，会加剧这些流变学问题。结果表明，全髋关节置换患者的管理应包括血液流变学方面的考虑（如术前有意进行血液稀释）和术后早期活动。
