Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis
Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis
复制标题
DOI：
10.3760/cma.j.issn.0366-6999.2011.11.009
复制
发表时间：
2011-06-05
影响因子：
6.1
通讯作者：
Cao Guang-le
中科院分区：
文献类型：
--
作者：
Shen Hui-liang;Li Zheng;Cao Guang-le
全膝关节置换术（TKA）是治疗各种晚期膝关节疾病的重要手段。然而，已经观察到患者术后血红蛋白（HB）计数较低，这与测量的失血量显著不一致。虽然隐性失血的概念在2000年就已经提出，但从那时起临床上很少关注。本研究探讨膝关节骨关节炎全膝关节置换术后隐性失血的特点及影响因素。方法回顾性分析108例膝关节骨关节炎患者，其中男性42例，女性66例。采用Gross公式计算全膝关节置换术围手术期出血量和隐性出血量。影响围手术期和隐性失血的潜在因素包括性别、手术时间、止血带使用时间、止血（术中止血带放气）和回收血回输。结果围手术期平均失血量为（1553 ± 356）ml，隐性失血量为（793 ± 223）ml。男性隐性失血量明显高于女性，术中使用放气止血带止血可减少隐性失血量。结论Gross公式计算隐性失血量时，应选择红细胞压积最低值作为参数，以免低估隐性失血量。与女性相比，男性的隐性失血量无显著差异。术中使用放气止血带止血可减少隐性失血。回收血回输虽不能减少围术期失血或隐性失血，但仍是降低输血率的有效方法。中华医学杂志2011;124（11）：1653-1656
Background Total knee arthroplasty (TKA) is an important therapy for the treatment of various late-stage knee diseases. However, it has been observed that patients have lower hemoglobin (HB) counts postoperatively, which are significantly inconsistent with the measured blood loss. Although the concept of hidden blood loss has been presented in 2000, very little clinical attention has been paid since then. In this study, we investigated the characteristics and influential factor of hidden blood loss after TKA in treating knee osteoarthritis.Methods One hundred and eight patients, with 42 males and 66 females, were retrospectively analyzed. The perioperative blood loss and the hidden blood loss following TKA were calculated by Gross formula. Potential factors affecting perioperative and hidden blood loss included gender, surgical time, tourniquet time, hemostasis (during operation with deflating tourniquet), and reinfusion of salvaged blood.Results The average perioperative blood loss was found to be (1553 +/- 356) ml and the average hidden blood loss was (793 +/- 223) ml. The hidden blood loss of the male was significantly higher than that of the female, and was reduced by hemostasis during the operation with a deflating tourniquet. Hidden blood loss was not affected by postoperative blood salvage and reinfusion, surgical time, or tourniquet time.Conclusions When calculating the value of hidden blood loss by Gross formula, the lowest value of hematocrit should be chosen as the parameter so that hidden blood loss would not be underestimated. No significant differences could be found in hidden blood loss for males compared to females. Hidden blood loss can be reduced by hemostasis during operation with a deflating tourniquet. Although reinfusion of salvaged blood could not reduce the perioperative blood loss or hidden blood loss, it was still an effective method to reduce transfusion rate. Chin Med J 2011;124(11):1653-1656