老年全髋置换围术期三种血液管理方式的比较△

Comparison of three blood managements during perioperative period of total hip arthroplasty in the elderly

摘要:

［目的］ 比较老年全髋关节置换 （total hip arthroplasty, THA） 围手术期三种不同血液管理方式的作用效果。［方法］ 2018 年 8 月—2021 年 10 月，65 岁以上拟行单侧 THA 的激素性股骨头坏死患者 60 例纳入本研究，采用随机数字表法随机分为三组。常规组 20 例，应用氨甲环酸；富氢组 20 例，应用氨甲环酸联合富氢水；联合组 20 例，应用氨甲环酸联合富氢水及铁剂。分析临床结果和检验学指标及其之间的相关性。［结果］三组患者均顺利完成手术。各组手术时间和术中出血量的差异无统计学意义（P>0.05），联合组总失血量、术后引流量以及隐性失血量明显低于其他两组（P<0.05）。联合组输血例数显著少于其他两组 （P<0.05）。术后相应时间点，联合组的 VAS 评分均显著低于其他两组 （P<0.05），ROM 和 Harris 评分显著高于其他两组 （P<0.05）。术前三组 CRP、IL-6、Hb 及 Hct 的差异均无统计学意义（P>0.05），术后 1 d 三组间 CRP 差异均无统计学意义（P> 0.05），而联合组 IL-6 显著低于其余两组（P<0.05）；术后 3~7 d，联合组的 CRP 和 IL-6 显著低于其余两组（P<0.05），术后 1~7 d，联合组的 Hb 和 Hct 显著高于其余两组（P<0.05）。对比发现，各临床结果与检验学指标具有一定的相关性。［结论］氨甲环酸联合富氢水及铁剂能有效缓解老年激素性股骨头坏死患者 THA 围术期炎性反应，减少围术期失血量，促进 Hb 及 Hct 的恢复， 改善髋关节功能。

Abstract:

[Objective] To compare the effects of three perioperative blood managements during total hip arthroplasty (THA) in the el- derly. [Methods] From August 2018 to October 2021, a total of 60 elderly patients who were undergoing unilateral total hip arthroplasty for corticosteroid-induced osteonecrosis of the femoral head were included in this study and were divided into three groups by random number table method. Of them, 20 patients in conventional group were treated with tranexamic acid, 20 patients in hydrogen-rich group were treated with tranexamic acid and hydrogen-rich water, while the renmaining 20 patients in the combined group had tranexamic, hydrogen-rich wa- ter and received additionally postoperative intravenous iron. The document regarding clinical presentations and laboratory test, as well as their correlation were analysized. [Results] All patients in the three groups had THA completed successfully. Although no significant differ- ences in the operation time and intraoperative blood loss were found among the 3 groups (P>0.05) , the combined group had significantly less postoperative drainage volume, total blood loss and invisible blood loss than the other two groups (P<0.05) . Some patients in the three groups had blood transfusion after operation, and the number of patients in the combined group was the least (P<0.05) . In addition, VAS score of the combined group was significantly lower than those of the other two groups (P<0.05) . The hip range of motion (ROM) and Harris score in- creased significantly over time in all the 3 groups (P<0.05) , which proved significantly better in the combined group than the other two groups at the corresponding time point (P<0.05) . Additionally, hemoglobin (Hb) and hematocrit (Hct) had the highest level in the combined group compared with the other two groups (P<0.05) , while IL-6 was the lowest in the combined group at corresponding time point (P<0.05) . In terms of CRP, the combined group was significantly lower than the other two groups from 3 to 7 days after operation (P<0.05) . What is more, it was found that there was a certain correlation between the clinical results and the laboratory indicators. [Conclusion] Tranexamic acid combined with hydrogen-rich water and iron does significantly alleviate the pain, promote the recovery of Hb and Hct, improve function- al recovery during perioperative period of THA for corticosteroid-induced femoral head necrosis in the elderly.