CAJ | 학술논문

目的：调查全膝关节置换术（total knee arthroplasty， TKA）围手术期异体输血率并分析其相关影响因素。方法回顾性分析北京协和医院骨科2005年1月至2011年12月临床资料完整的初次TKA患者共1165例，其中男217例，女948例；平均年龄62.4岁（16～92岁）。调查患者围手术期异体输血率。对纳入研究的617例单侧TKA病例的自变量（包括34个影响因素）和因变量（住院期间异体输血）进行统计分析，用多因素Logistic回归分析确定住院期间异体输血的影响因素。结果1165例TKA手术患者总异体输血率为58.2％（678/1165），平均异体输血量为2.7 U （1～13 U）。其中695例单侧TKA患者异体输血率为40.0％（278/695）；470例一期双侧TKA患者异体输血率为85.1％（400/470）。共617例单侧TKA病例进入统计分析，单因素分析显示患者年龄（ P＜0.0001）、术前血红蛋白水平（ P＜0.0001）、术前血细胞比容（P＜0.0001）、美国麻醉医师学会（American Society of Anesthesiologists， ASA）评分≥3分（P＝0.004）、手术时间（ P＝0.004）和止血带时间（ P＝0.050）与异体输血呈显著相关；多因素Logistic 回归分析证实异体输血和年龄（P＜0.0001）、术前血红蛋白水平（P＜0.0001）、手术时间（P＜0.0001）之间呈显著相关。结论 TKA围手术期异体输血率较高。一期双膝同期置换更需注意术后贫血事件的发生。通过评估患者年龄、血红蛋白水平及手术时间，有利于预测术后异体输血的需求。
목적：조사전슬관절치환술（total knee arthroplasty， TKA）위수술기이체수혈솔병분석기상관영향인소。방법회고성분석북경협화의원골과2005년1월지2011년12월림상자료완정적초차TKA환자공1165례，기중남217례，녀948례；평균년령62.4세（16～92세）。조사환자위수술기이체수혈솔。대납입연구적617례단측TKA병례적자변량（포괄34개영향인소）화인변량（주원기간이체수혈）진행통계분석，용다인소Logistic회귀분석학정주원기간이체수혈적영향인소。결과1165례TKA수술환자총이체수혈솔위58.2％（678/1165），평균이체수혈량위2.7 U （1～13 U）。기중695례단측TKA환자이체수혈솔위40.0％（278/695）；470례일기쌍측TKA환자이체수혈솔위85.1％（400/470）。공617례단측TKA병례진입통계분석，단인소분석현시환자년령（ P＜0.0001）、술전혈홍단백수평（ P＜0.0001）、술전혈세포비용（P＜0.0001）、미국마취의사학회（American Society of Anesthesiologists， ASA）평분≥3분（P＝0.004）、수술시간（ P＝0.004）화지혈대시간（ P＝0.050）여이체수혈정현저상관；다인소Logistic 회귀분석증실이체수혈화년령（P＜0.0001）、술전혈홍단백수평（P＜0.0001）、수술시간（P＜0.0001）지간정현저상관。결론 TKA위수술기이체수혈솔교고。일기쌍슬동기치환경수주의술후빈혈사건적발생。통과평고환자년령、혈홍단백수평급수술시간，유리우예측술후이체수혈적수구。
Objective To evaluate the transfusion rates and identify perioperative factors associated with allogeneic blood transfusion ( AllTx) after primary total knee arthroplasty ( TKA) with routine use of low-molecu-lar-weight heparins .Methods We retrospectively studied the transfusion rate of 1165 consecutive patients who underwent primary TKA between January 2005 and December 2011 .Totally 34 independent variables were ana-lyzed in 617 primary unilateral TKAs without autologous blood predonation for requirement of AllTx .Multiple re-gression analysis model was used to identify risk factors associated with perioperative blood transfusion .Results Overall, 58.2% (678/1165 ) of patients required AllTx .The median number of units transfused was 2.7 U ( range:1 to 13 U).The AllTx rate was 40.0%(278/695) in unilateral TKA procedures and 85.1%(400/470) in one-stage bilateral TKA procedures .Univariate analysis demonstrated the risk of transfusion was independently predicted by the patients'age at surgery ( P<0.0001 ) , preoperative hematocrit ( P<0.0001 ) , preoperative he-moglobin concentration (P<0.0001), American Society of Anesthesiologists (ASA) score ≥3 (P=0.004), surgical time ( P=0.004 ) , and tourniquet time ( P=0.050 ) .Multivariate Logistic regression analysis confirmed significant relationship between allogeneic blood transfusion and age ( P <0.0001 ) , preoperative hemoglobin ( P<0.0001 ) , and surgical time ( P<0.0001 ) .Conclusions AllTx rate is high in TKA procedures , especial-ly in one-stage bilateral TKA procedures .Patient's age, preoperative hemoglobin level , and surgical time are helpful in identifying high-risk patients who require postoperative blood transfusion .