| 术前自体血采集预防髋关节置换术后血栓性疾病的作用 |
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Received:July 29, 2012
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| 期刊信息：《中国骨伤》2013年26卷，第1期，第38-40页 |
| DOI：10.3969/j.issn.1003-0034.2013.01.010 |
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目的：研究术前自体血采集对预防髋关节置换术后血栓性疾病的有效性.
方法：收集2007年1月年至2010年3月收集在纽约特种外科医院(Hosptal for Special Surgery, HSS)医院行全髋关节置换术912例患者的临床资料,其中男428例,女484例.排除标准为有出血体质及不能行硬膜外麻醉的患者.患者年龄24～93岁,平均(65.28±11.90)岁.骨性关节炎835例(91.3%),股骨头坏死32例(3.6%),髋关节发育不良20例(2.3%),类风湿性关节炎20例(2.2%),其他诊断5例(0.6%).手术采用硬膜外低压麻醉(平均动脉压维持在45～55 mmHg),手术采用后外侧切口,尽量减少股静脉扭曲的时间,反复冲洗和吸引出股骨髓腔内容物.当处理髋臼侧的时候,下肢处于中立位置.处理股骨侧髓腔之前1～2 min,静脉给予肝素(10～15 U/kg).所有患者随访至少3个月,无一例失访.
结果：752例术前进行了自体血捐献,160例没有捐献自体血.共11例发生血栓性疾病,占患者总数的1.3%,其中5例术前捐献自体血,6例术前未捐献自体血,两者血栓性疾病发病率差异有统计学意义(P=0.021).所有血栓患者中8例确诊为深静脉血栓形成,发生率为0.8%;所有血栓患者中有症状并且诊断为肺栓塞的3例,发生率为0.5%,无致命性的肺栓塞PE.
结论：髋关节置换术前捐献自体血能降低术后血栓性疾病的发生率. |
| [关键词]:关节成形术,置换,髋 静脉血栓形成 肺栓塞 |
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| Effect of preoperative donation of autologous blood on venous thromboembolism disease after total hip replacement |
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Abstract:
Objective:To evaluate the effect of preoperative donation of autologous bood on venous thromboembolism (VTE) after total hip arthroplasty (THA).
Methods:Between Jan. 2007 and March. 2010,912 consecutive patients who had THAs performed in Hosptal for Special Surgery were collected,excluded patients with thrombocytopenia or pre-exising bleeding diathesis and patients for whom epidural analgesia was not possible. Among them,there were 428 males and 484 females with an average age of (65.28±11.90) years (ranged from 24 to 93 years). Among them,835 cases (91.3%) had osteoarthritis,32 cases (3.6%) had osteonerrosis,20 cases (2.3%) had dysplasia,20 cases (2.2%) had rheumatoid arthritis,and 5 cases (0.6%) had other diagnoses. The surgeries were performed under hypotensive epidural anestheisa (mean arterial pressure between 45 to 55 mm Hg) and through a posterolateral approach,minimizing the duration of femoral vein obstruction and reducing the load of intramedullary content to the venous system by repeated pulsatile lavage and aspiration of the femoral canal. The lower extremity was in the neutral position while working on the acetabulum and flexed and internally rotated while working on the femur. Whenever possible,the lower extremity was extended to a neutral position to restore femoral venous flow. Patients received one bolus of unfractionated intravenous heparin (10 to 15 U/kg),1 to 2 minutes before femoral canal preparation. All patients were followed up at least 3 months postoperatively. No patient was lost to followed-up.
Results: Seven hundreds and fifty-two patients donated autologous blood before THA,160 did not donate autologoud blood. The incidence of clinical symoptomatic VTE was 1.3 %(11/912). Among the 11 patients with clinical symoptomatic VTE,5 donated blood pre-operation (0.66%,5/752) and 6 did not donate pre-operation(3.8%,6/160). The rate of VTE after THA between autologous blood donation and no blood donation was statistically significant (P=0.021<0.05. The incidence of deep vein thrombosis was 0.8%(8/912). Three patients had a symptomatic of Pulmonary embolism.
Conclusion:A significant decrease in the incidence of VTE is noted in those who had donated blood preoperatively compared with those who had not. |
| KEYWORDS:Arthroplasty,replacement,hip Venous thrombosis Pulmonary embolism |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 鲁宁,杨阳,Alejandro González Della Valle,Eduardo A. Salvati.术前自体血采集预防髋关节置换术后血栓性疾病的作用[J].中国骨伤,2013,26(1):38~40 |
| 英文格式: | LU Ning,YANG Yang,Alejandro González Della Valle,Eduardo A. Salvati.Effect of preoperative donation of autologous blood on venous thromboembolism disease after total hip replacement[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(1):38~40 |
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