Blood management of staged bilateral total knee arthroplasty in a single hospitalization period
Blood management of staged bilateral total knee arthroplasty in a single hospitalization period
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DOI：
10.1186/s13018-014-0116-1
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发表时间：
2014-11-13
影响因子：
2.6
通讯作者：
Pei, FuXing
中科院分区：
文献类型：
--
作者：
Ma, Jun;Huang, ZeYu;Pei, FuXing
前言：关于双侧分期一期全膝关节置换术（TKA）患者单次住院期间血液管理的研究文献很少。因此，本研究旨在评估新引入的多模式血液管理（MBM）在这些患者中的有效性和安全性。材料与方法：回顾性比较2012-2013年同一住院期间70例双侧分期原发性TKA患者的围手术期参数，分为两组，分别为新引入MBM组（a组，n = 33）和对照组（B组，n = 37）。新引入的MBM方案包括术前血红蛋白（Hb）评估，高蛋白饮食，皮肤闭合后释放止血带，术前口服铁治疗和股管封闭，一剂氨甲环酸（TXA） IV，必要时再加一剂。而在对照组中，仅使用常规的血液保存技术。结果：A组输血率为9% (3/33)，B组输血率为32.4%（12/37）。A组在术后Hb和红细胞压积（Hct）、术后疼痛、肿胀、术后疼痛、住院时间和住院费用方面也有显著的益处。所有患者均无深静脉血栓（DVT）发生。结论：在单次住院期间，新引入的MBM可有效减少双侧TKA的出血量、疼痛和膝关节肿胀，而不会导致并发症的增加，并可显著节省成本。
Introduction: Few literatures have studied the blood management in patients treated with staged bilateral primary total knee arthroplasty (TKA) in a single hospitalization period. Therefore, this study aims to evaluate the effectiveness and safety of the newly introduced multimodal blood management (MBM) in these patients.Materials and methods: We retrospectively compared the perioperative parameters in 70 cases undergoing staged bilateral primary TKA in a single hospitalization period from 2012-2013 in a single center with two different groups of patients, allocating cases to the group with the newly introduced MBM (Group A, n = 33) and controls to the group without the newly introduced MBM (Group B, n = 37). The newly introduced MBM protocols include preoperative hemoglobin (Hb) evaluation, high protein diet, tourniquet release after skin closure, preoperative oral iron treatment and femoral canal obturation, and one dose of tranexamic acid (TXA) IV with another one if necessary. While in the control group, only routine blood-saving techniques were used.Results: Group A had a transfusion rate of 9% (3/33), whereas 32.4% of patients (12/37) in Group B received allogenic blood transfusion. Significant benefits were also found in Group A in terms of postoperative Hb and hematocrit (Hct), reduction of postoperative pain, swelling, postoperative pain, length of stays, and hospital costs. No deep vein thrombosis (DVT) events were found in all these patients.Conclusions: The newly introduced MBM in staged bilateral TKA in a single hospitalization period can reduce blood loss effectively as well as pain and knee joint swelling instead of leading to increased complications and result in significant cost savings.