IR@PKUHSC  > 北京大学第四临床医学院
学科主题外科学
单侧全膝关节置换术后输血相关因素初步研究
宋洋
2016-05-26
导师田伟
专业外科学
授予单位北京大学
授予地点北京大学第四临床医学院
学位博士
关键词人工全膝关节置换术 单侧 术后输血 危险因素
其他题名Analyses risk factors of allogeneic transfusion after unilateral total knee arthroplasty
分类号R687.4
摘要

目的:探究、发现人工全膝关节置换术后输血相关危险因素,为降低术后输血率、更好地进行围手术期管理提供参考。

方法与对象:研究对象为2014年1月1日至2014年12月31日期间在本院矫形骨科病区住院行初次单侧人工膝关节置换术的病人,采集病人基本信息,术前实验室及影像学检查结果,手术及术后输血信息,术后并发症的发生从交班本中获取,并从病历记录和会诊记录中了解详细诊治过程。采用单因素分析及多元回归分析术后输血相关危险因素。

结果:最终共有852位病人纳入本研究。其中女性663(77.8%)人,平均年龄64.9岁,术前血红蛋白低于正常值患者 71(8.3%) 人,术前红细胞压积低于正常值患者 27(3.2%)人,术中使用氨甲环酸患者 740(86.9%)人,输血患者 202(23.7%)人,术后不良事件 41(4.5%)人。女性(OR 2.283,CI 1.405~3.711)、年龄≥70岁(OR 2.048,CI 2.064~4.292)、术前贫血(OR 1.506,CI 1.376~4.427)、术前红细胞压积低于正常值(OR 3.412,CI 1.086~6.591)均为术后输血的独立危险因素,未使用氨甲环酸相对于使用氨甲环酸患者(OR 3.412, CI 2.798~6.654)术后输血率明显提高。“周末效应”将导致节前一天手术患者当天输血率升高。

结论:我们研究得出术前评估及围手术期管理要对同时存在一个或多个高位因素(女性、≥70岁、术前贫血、红细胞压积低于正常值)患者给予充分准备以减少输血相关疾病的发生。同时在围手术期血液管理过程中警惕“周末效应”对临床医师把握输血指征的影响,以及对于手术当天输血要严格把控。

 

英文摘要

Objective The purpose of this study was to investigate the acteristics and risk factors of allogeneic transfusion after unilateral total knee arthroplasty, so as to decrease transfusion rate and help clinical decision-making.

Methods All patients undergoing primary unilateral total knee arthroplasty from Jan 2014 to Dec 2013 were included in this study. Data including demographic information, history, anesthesia, surgery, postoperative allogeneic transfusion information, and the post-operative complications were recorded from the health record management system of the hospital. Analyses of the acteristics and risk factors of allogeneic transfusion were performed with the one-way analysis of variance and logistic multiple regression.

Results A total of 852 primary unilateral total knee arthroplasties had been performed in the study. 77.8% (663) of patients were female. The average age of patients was 64.9 years. 8.3% (71) of patients were preoperative anemia. 3.2% (27) of patients hematokrit were below the normal. 86.9% (740) of patients were used tranexamic acid during the operation. 23.7% (202) of the patients had allogeneic transfusion after the surgeries. 4.5% (41) of the patients had post-operative complications. Female (odds ratio [OR] = 2.283; 95% confidence interval [CI] = 1.405 to 3.711), patient age of 70 years or older (OR = 2.976; 95% CI = 2.064 to 4.292), preoperative anemia (OR = 2.468, 95%CI = 1.376 to 4.427) and preoperative hematocrit below normal (OR = 2.676, 95% CI = 1.086 to 6.591) were independent predictors of postoperative allogeneic transfusion. The patients who did not use tranexamic acid had a higher transfusion rate (OR = 4.315, 95%CI = 2.798 to 6.654). “The weekend effect ” could make a real influence on the doctors when they made a transfusion decision.

 

Conclusion Perioperative management is important, especially for those patients with female, older age or preoperative anemia. During the perioperative management, we should be careful of “The weekend effect”. We should be serious about transfusion in next day of the operation.

语种中文
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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/124761
专题北京大学第四临床医学院
作者单位北京大学第四临床医学院
推荐引用方式
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宋洋. 单侧全膝关节置换术后输血相关因素初步研究[D]. 北京大学第四临床医学院. 北京大学,2016.
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