|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|
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。
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.
|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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