Bierbaum B E, Callaghan J J, Galante J O, Rubash H E, Tooms R E, Welch R B
New England Baptist Hospital, Chestnut Hill, Massachusetts 02167, USA.
J Bone Joint Surg Am. 1999 Jan;81(1):2-10. doi: 10.2106/00004623-199901000-00002.
Three hundred and thirty orthopaedic surgeons in the United States participated in a study of transfusion requirements associated with total joint arthroplasty. A total of 9482 patients (3920 patients who had a total hip replacement and 5562 patients who had a total knee replacement) were evaluated prospectively from September 1996 through June 1997. Of those patients, 4409 (46 percent [57 percent of the patients who had a hip replacement and 39 percent of the patients who had a knee replacement]) had a blood transfusion. Two thousand eight hundred and ninety patients (66 percent) received autologous blood, and 1519 patients (34 percent) received allogenic blood. Ordered logistic regression analysis showed the most important predictors of the transfusion of allogenic blood to be a low baseline hemoglobin level and a lack of predonated autologous blood. Preoperative donation of autologous blood decreases the risk of transfusion of allogenic blood; however, inefficiencies in the procedures for obtaining autologous blood were identified. Sixty-one percent (5741) of the patients had predonated blood for autologous transfusion, but 4464 (45 percent) of the 9920 units of the predonated autologous blood were not used. Primary procedures and revision total knee arthroplasty were associated with the greatest number of wasted autologous units. Of the 5741 patients who had predonated blood, 503 (9 percent) needed a transfusion of allogenic blood. The frequency of allogenic blood transfusion varied with respect to the type of operative procedure (revision total hip arthroplasty and bilateral total knee arthroplasty were associated with the highest prevalence of such transfusions) and with a baseline hemoglobin level of 130 grams per liter or less. Transfusion of allogenic blood was also associated with infection (p < or = 0.001), fluid overload (p < or = 0.001), and increased duration of hospitalization (p < or = 0.01). These latter findings warrant further evaluation in controlled studies.
美国330名骨科医生参与了一项关于全关节置换术输血需求的研究。从1996年9月至1997年6月，对9482例患者（3920例行全髋关节置换术，5562例行全膝关节置换术）进行了前瞻性评估。在这些患者中，4409例（46%[髋关节置换术患者中的57%和膝关节置换术患者中的39%]）接受了输血。2890例（66%）患者接受了自体血，1519例（34%）患者接受了异体血。有序逻辑回归分析显示，异体血输血的最重要预测因素是基线血红蛋白水平低和缺乏预先捐献的自体血。术前捐献自体血可降低异体血输血风险；然而，发现获取自体血的程序存在效率低下的问题。61%（5741例）患者预先捐献了自体输血用血，但在预先捐献的9920单位自体血中，有4464单位（45%）未被使用。初次手术和全膝关节置换翻修术与浪费的自体血单位数量最多相关。在5741例预先捐献血液的患者中，503例（9%）需要异体血输血。异体血输血的频率因手术类型而异（全髋关节置换翻修术和双侧全膝关节置换术与此类输血的最高患病率相关），且与基线血红蛋白水平为每升130克或更低有关。异体血输血还与感染（p≤0.001）、液体超负荷（p≤0.001）和住院时间延长（p≤0.01）相关。后一项发现值得在对照研究中进一步评估。
