目的:观察不同输血方式对高龄骨科手术患者术后转归的影响.方法:将90例择期骨科手术患者根据术中不同输血模式分为异体输血组(A组)和自体输血组(B组),自体+异体输血组(C组),每组各30例.患者全身麻醉后,桡动脉采血检测Hb、Hct值;观察并记录术中失血量、异体输血量、自体输血量、尿量、手术时间及液体输入量;分别于术前、术后、术后1 d、3 d、5 d采集静脉血用流式细胞仪检测CD3+、CD4+及NK细胞百分比;术前1d、术后1 d、3 d、7 d记录15项恢复质量量表(QoR-15)评分及术后住院时间.结果:C组出血量多于B组,差异有统计学意义(P＜0.05);A组术后、术后1 d、3 d、5 d的CD3+、CD4+和NK细胞百分比均低于术前,差异有统计学意义(P＜0.05),B组术后1 d、3 d、5 d CD3+、CD4+细胞百分比,C组术后3 d CD4+细胞百分比,术后5 d CD3+细胞百分比均高于A组,差异有统计学意义(P＜0.05);B、C两组在术后1 d、3 d QoR-15评分均高于A组,差异有统计学意义(P＜0.05),C组在术后1 d、3 d QoR-15评分均低于B组,差异有统计学意义(P＜0.05);多因素回归显示B组术后住院时间低于A组,差异有统计学意义(P＜0.05),C组术后住院时间与A组比较,差异无统计学意义(P=0.69).结论:回收式自体输血(IOCS)应用于高龄骨科手术患者,相对于异体输血可有效促进患者术后转归,提高术后早期恢复质量,缩短术后住院时间.
Study on the Effect of Different Blood Transfusion Methods on Postoperative Regression in Elderly Orthopedic Surgery Patients
Objective:To observe the effect of different blood transfusion methods on postoperative regression in elderly ortho-pedic surgery patients.Methods:90 patients undergoing elective orthopedic surgery were divided into allogeneic transfusion group(Group A),autologous transfusion group(Group B),and autologous + allogeneic transfusion group(Group C)according to different intraoperative transfusion modes.After general anesthesia of the patients,blood was collected from radial artery to detect Hb and Hct values.Intraoperative blood loss,allogeneic blood transfusion,autologous blood transfusion,urine volume,operation time and fluid input were observed and recorded.Venous blood was collected preoperatively,postoperatively,and 1 d,3 d,and 5 d postoper-atively to detect CD3+,CD4+,and NK cell percentages by flow cytometry.The 15-item Quality of Recovery Scale(QoR-15)scores were recorded 1 d preoperatively,1 d,3 d,and 7 d postoperatively,and postoperative hospitalization time was recorded.Results:The bleeding volume of group C was significantly more than that of group B,and the difference was statistically significant(P＜0.05).The percentages of CD3+,CD4+,and NK cells in group A were significantly lower than those in the preoperative period after operation,and at 1 d,3 d,and 5 d postoperatively,and the differences were statistically significant(P＜0.05).The percentages of CD3+ and CD4+ cells at 1 d,3 d,and 5 d postoperatively in group B,the percentages of CD4+ cells at 3 d postoperatively in group C,and the percentages of CD3+ cells at 5 d postoperatively in group C were significantly higher than those in group A,and the dif-ferences were statistically significant(P＜0.05).QoR-15 scores were significantly higher than those in group A in groups B and C at 1 d and 3 d postoperatively,and the differences were statistically significant(P＜0.05).QoR-15 scores in Group C were signifi-cantly lower than those in Group B at 1 d and 3 d postoperatively,and the difference was statistically significant(P＜0.05).Multi-factorial regression showed that the postoperative hospitalization time in group B was significantly lower than that in group A,and the difference was statistically significant(P＜0.05).There was no statistically significant difference between the postoperative hos-pitalization time in group C and that in group A(P=0.69).Conclusion:Recovered autologous blood transfusion(IOCS)applied to el-derly orthopedic surgical patients can effectively promote patients'postoperative regression,improve the quality of early postopera-tive recovery,and shorten the duration of postoperative hospitalization relative to allogeneic blood transfusion.
Different transfusion modalitiesOrthopedic surgeryElderly patientsT lymphocyte subsetsPostoperative regression
万方数据
维普
