| 刘更夫,张远金,贺桂文,等.多种血液保护方法在骨科围术期的联合应用.骨科,2015,6(1): 32-35. |
| 多种血液保护方法在骨科围术期的联合应用 |
| Combined application of blood conservation methods in perioperative periods of orthopaedics |
| 投稿时间：2014-08-23 |
| DOI：10.3969/j.issn.1674-8573.2015.01.009 |
| 中文关键词: 血液保护 血液流变学 骨科手术 围术期 |
| 英文关键词: Blood conservation Hemorheology Orthopaedics surgery Perioperative period |
| 基金项目: |
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| 中文摘要: |
| 目的 观察联合多种技术手段、药物对骨科手术患者失血、凝血功能和血液氧合状态的影响以及实施血液保护的效果。方法 选择2013年2月至2014年1月在我院就诊的271例骨科手术治疗患者，术前行储存式自体输血，术中采用控制性降压技术、稀释式或回收式自体输血技术，并使用凝血药物等；观察患者手术前后血红蛋白（hemoglobin, Hb）、红细胞比容（red blood cell specific volume, Hct）、血小板计数（blood platelets count, BPC）、活化部分凝血活酶时间（activated partial thromboplastin time, APTT）、凝血酶原时间（prothrombin time, PT）、血浆黏度、全血黏度以及混合静脉血氧分压(mixed venous blood oxygen tension, PvO2)、混合静脉血氧饱和度(mixed venous oxygen saturation, SvO2)等指标的变化，对比分析实施血液保护对患者贫血程度、凝血功能、血液流变学以及血液氧合状态的影响。结果 本组病例围术期自体输血共179 010 mL，异体输血共35 000 mL，未出现输血不良反应；患者术后Hb、Hct、BPC、血浆黏度、全血黏度均低于术前，差异均有统计学意义（均P<0.05），PvO2、SvO2较术前有所升高，但差异均无统计学意义（均P>0.05），APTT、PT手术前后无明显变化，差异均无统计学意义（均P＞0.05）。结论 骨科围术期联合应用多种血液保护方法能明显减少失血，减少异体输血，保护血液资源，且未对患者凝血功能、氧合状态产生明显影响。 |
| 英文摘要: |
| Objective To discuss the influence of combined application of special techniques and medicines on blood loss, blood coagulation function, and blood oxygenation in the perioperative periods of orthopaedics and the results of blood conservation. Methods From Feb. 2013 to Jan. 2014, 271 patients undergoing orthopaedics surgery in our hospital were enrolled in this study. Preoperative autologous donation was adopted. The way of controlled hypotension, autologous blood and the use of anticoagulant drugs were performed in the operative periods. Changes of Hb, Hct, BPC, APTT, PT, and PvO2 values were observed before and after operation. Results 271 patients were given a transfusion of 179 010 mL autologous blood and 35 000 mL allogeneic blood in total. No adverse reactions were found. The Hb, Hct, BPC and hemorheologic values before operation were significantly lower than those after operation (P<0.05 for all). The PvO2 and SvO2 before operation were higher than those after operation, but there was no statistically significant difference (P>0.05 for all). There were no significant difference in APTT and PT (P>0.05 for all). Conclusion Combined application of blood conservation methods in the perioperative periods of orthopedics can decrease the amount of bleeding, reduce allogeneic blood transfusion, protect blood resources, and have no significant influence on the blood coagulation function and blood oxygenation. |
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