中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (53): 8537-8542.doi: 10.3969/j.issn.2095-4344.2015.53.002

• 人工假体 artificial prosthesis • 上一篇    下一篇

膝关节置换后异体输血预测模型的建立及精确度检测

周治国,方广文,张英剑,吕廷灼,商福清,王淑平,段少华   

  1. 天津医科大学宝坻临床学院骨科,天津市 301800
  • 收稿日期:2015-10-31 出版日期:2015-12-24
  • 通讯作者: 方广文,硕士,副主任医师,天津医科大学宝坻临床学院骨科,天津市 301800
  • 作者简介:周治国,男,1973年生,天津市人,汉族,2009年天津医科大学毕业,硕士,副主任医师,主要从事四肢创伤与关节方面的研究。

The establishment of allogeneic blood transfusion prediction model and precise detection after total knee arthroplasty

Zhou Zhi-guo, Fang Guang-wen, Zhang Ying-jian, Lv Ting-zhuo, Shang Fu-qing, Wang Shu-ping,
Duan Shao-hua   

  1. Department of Orthopaedics, Baodi Clinical College of Tianjin Medical University, Tianjin 301800, China
  • Received:2015-10-31 Online:2015-12-24
  • Contact: Fang Guang-wen, Master, Associate chief physician, Department of Orthopaedics, Baodi Clinical College of Tianjin Medical University, Tianjin 301800, China
  • About author:Zhou Zhi-guo, Master, Associate chief physician, Department of Orthopaedics, Baodi Clinical College of Tianjin Medical University, Tianjin 301800, China

摘要:

背景:如何有效减少膝关节置换后异体输血量已成为临床新的难题,而围置换期的失血和置换后异体输血的预测因素尚不完全明确。
目的:通过分析置换前和置换术中影响置换后异体输血量的相关因素,建立膝关节置换后异体输血量的预测模型,为临床选择性应用自体血液回输器提供理论依据。
方法:回顾性分析天津医科大学宝坻临床学院自2012年1月至2013年12月收治的120例单侧膝关节置换后异体输血患者的资料,详细记录每例患者的性别、年龄、身高、体质量、置换前血红蛋白值、手术时间、术中失血量及置换后异体输血量,据此建立一个膝关节置换后异体输血量的预测模型。自2014年1至12月将此模型应用于临床,将90例预测单侧膝关节置换后需要异体输血的患者随机分成两组,观察组应用自体血液回输器,对照组应用常规引流装置。对两组患者的输血量进行统计分析,并检测预测模型的预测精确度。
结果与结论:所有患者均完成试验观察,预测模型试验中Pearson分析显示,置换后异体输血量与患者年龄、身高、体质量、置换前血红蛋白值、手术时间和术中失血量相关(P < 0.01),多变量回归分析发现置换后异体输血与患者置换前血红蛋白值、手术时间、术中失血量相关(P < 0.01)。临床应用试验结果显示,观察组与对照组患者置换后预测异体输血量分别为(611.30±191.14) mL和(571.55±200.53) mL,预测精确度分别为(71.50±22.20)%和(70.94±19.23)%,差异均无显著性意义(P > 0.05)。两组患者异体输血量、输血总量(包括自体输血量和异体输血量)之间的差异有显著性意义(P < 0.01),观察组的异体输血量显著低于对照组。提示预测模型能成功预测膝关节置换后异体输血量,预测置换后需要异体输血的患者应用自体血液回输器可以有效的减少异体输血量。 

关键词: 骨科植入物, 人工假体, 输血, 膝关节置换, 异体血, 自体血

Abstract:

BACKGROUND: How to effectively reduce allogeneic blood transfusion volume after knee arthroplasty has become a new clinical problem, but predictors of perioperative blood loss and allogenic blood transfusion after replacement have not been well defined.
OBJECTIVE: To establish the prediction model of allogeneic transfusion volume after total knee arthroplasty by analyzing the preoperative and intraoperative related factors that influence the postoperative allogeneic transfusion volume, so as to provide a theoretical basis for the clinical selective application of the autologous blood retransfusion device.

 

METHODS: The materials of 120 postoperative allogenic transfusion patients who treated with unilateral total knee arthroplasty at Baodi Clinical College of Tianjin Medical University from January 2012 to December 2013 were retrospectively analyzed. Each patient’s gender, age, height, body weight, preoperative hemoglobin value, operation time, intraoperative blood loss volume and postoperative allogeneic transfusion volume were recorded in detail, and accordingly a prediction model of allogeneic transfusion volume was established after total knee arthroplasty. From January 2014 to December 2014, we applied this model in clinic. A total of 90 patients who predicted need for allogeneic transfusion after unilateral total knee arthroplasty were randomly divided into two groups. Autologous blood retransfusion device was used in the observation group. Conventional drainage was used in the control group. The blood transfusion volume of patients in these two groups was analyzed, and the prediction accuracy of the prediction model in these two groups was detected.

RESULTS AND CONCLUSION:All patients completed the experimental observation. Pearson analysis showed that the patient’s age, height, body weight, preoperative hemoglobin values, operation time and intraoperative blood loss volume associated with postoperative allogeneic transfusion volume (P < 0.01). Multivariate regression analysis showed that the patient’s preoperative hemoglobin values, operation time and intraoperative blood loss volume associated with postoperative allogeneic transfusion volume (P < 0.01). Clinical application test results showed that the postoperative allogeneic transfusion volume in observation and control groups was respectively (611.30±191.14) mL and (571.55±200.53) mL, prediction accuracy was respectively (71.50±22.20)% and (70.94±19.23)%, the difference was not significant (P > 0.05). There were significant differences in allogeneic transfusion volume and total blood transfusion volume (including autologous and allogeneic blood transfusion volume) of patients in these two group (P < 0.01). The allogeneic transfusion volume in the observation group was significantly lower than that in the control group. These results suggest that the prediction model can successfully predict the allogeneic transfusion volume after total knee arthroplasty. The application of autologous blood retransfusion device in those patients who predicted need for postoperative allogenic transfusion after the replacement can effectively reduce the allogenic transfusion volume.  

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