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术前自体血采集预防髋关节置换术后血栓性疾病的作用 预览 被引量:2

Effect of preoperative donation of autologous blood on venous thromboembolism disease after total hip replacement
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摘要 目的:研究术前自体血采集对预防髋关节置换术后血栓性疾病的有效性。方法:收集2007年1月年至2010年3月收集在纽约特种外科医院(HosptalforSpecialSurgery,HSS)医院行全髋关节置换术912例患者的临床资料,其中男428例,女484例。排除标准为有出血体质及不能行硬膜外麻醉的患者。患者年龄24~93岁,平均(65.28±11.90)岁。骨性关节炎835例(91.3%),股骨头坏死32例(3.6%),髋关节发育不良20例(2-3%),类风湿性关节炎20例(2.2%),其他诊断5例(0.6%)。手术采用硬膜外低压麻醉(平均动脉压维持在45—55mmHg),手术采用后外侧切口,尽量减少股静脉扭曲的时间,反复冲洗和吸引出股骨髓腔内容物。当处理髋臼侧的时候,下肢处于中立位置。处理股骨侧髓腔之前1—2min,静脉给予肝素(10-15U/kg)。所有患者随访至少3个月,无一例失访。结果:752例术前进行了自体血捐献,160例没有捐献自体血。共11例发生血栓性疾病,占患者总数的1.3%,其中5例术前捐献自体血,6例术前未捐献自体血,两者血栓性疾病发病率差异有统计学意义(P=0.021)。所有血栓患者中8例确诊为深静脉血栓形成,发生率为0.8%;所有血栓患者中有症状并且诊断为肺栓塞的3例,发生率为0.5%,无致命性的肺栓塞PE。结论:髋关节置换术前捐献自体血能降低术后血栓性疾病的发生率。 Objective :To evaluate the effect of preoperative donation of autologous bood on venous thromboembolism (VTE) after total hip arthroplasty (THA). Methods: Between Jan. 2007 and March. 2010,912 consecutive patients who had THAs performed in Hosptal for Special Surgery were collected, excluded patients with thrombocytopenia or pre-exising bleeding diathesis and patients for whom epidural analgesia was not possible. Among them,there were 428 males and 484 females with an average age of (65.28±11.90) years (ranged from 24 to 93 years). Among them,835 cases (91.3%) had osteoarthritis, 32 cases (3.6%) had osteonerrosis,20 cases (2.3%) had dysplasia,20 cases (2.2%) had rheumatoid arthritis,and 5 cases (0.6%) had other diagnoses. The surgeries were performed under hypotensive epidural anestheisa (mean arterial pressure between 45 to 55 mm Hg) and through a posterolateral approach, minimizing the duration of femoral vein obstruction and reducing the load of intramedullary content to the venous system by repeated pulsatile lavage and aspiration of the femoral canal. The lower extremity was in the neutral position while working on the aeetabulum and flexed and internally rotated while working on the femur. Whenever possible, the lower extremity was extended to a neutral position to restore femoral venous flow. Patients received one bolus of unfraetionated intravenous heparin (10 to 15 U/kg), 1 to 2 minutes before femoral canal preparation. All patients were followed up at least 3 months postoperatively. No patient was lost to followed-up. Results: Seven hundreds and fifty-two patients donated autologous blood before THA, 160 did not donate autologoud blood. The incidence of clinical symop- tomatic VTE was 1.3 % (11/912). Among the 11 patients with clinical symoptomatic VTE,5 donated blood pre-operation (0.66%, 5/752) and 6 did not donate pre-operation (3.8%, 6/160 ). The rate of VTE after THA between autologous blood donation and no blood donation was statistica
作者 鲁宁 杨阳 AlejandroGonzdlezDellaValle EduardoA.Salvati LU Niag, YA NG Yong,A lejandro Gonzalez Della Valle, and Eduardo A. Salvati. Department of Orthopaedics, the Second Hospital Affiliated to Kunming Medical College, Kunming 650101, Yunnan , China
出处 《中国骨伤》 CAS 2013年第1期38-40,共3页 China Journal of Orthopaedics and Traumatology
关键词 关节成形术 置换 静脉血栓形成 肺栓塞 Arthroplasty,replacement,hip Venous thrombosis Pulmonary embolism
作者简介 通讯作者:鲁宁Tel:0871-5351281-2383E—mail:luningwei2@163.com
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参考文献16

  • 1鲁宁,Eduardo A. Salvati.髋膝关节置换术后血栓性疾病预防[J].中国骨肿瘤骨病,2011,10(3):303-310. 被引量:6
  • 2邱贵兴,杨庆铭,余楠生,翁习生,王凯,李晓林.低分子肝素预防髋、膝关节手术后下肢深静脉血栓形成的多中心研究[J].中华骨科杂志,2006,26(12):819-822. 被引量:395
  • 3Westrich GH,Farrell C,Bono JV. The incidence of venous thromboembolism after total hip arthroplasty:a specific hypotensive epidural anesthesia protocol[J].Journal of Arthroplasty,1999,(04):456-463. 被引量:1
  • 4Pearson TC. Heamorheologic considerations in the pathogenesis of vascular occlusive events in polycythemia vera[J].Seminars in Thrombosis and Hemostasis,1997,(05):433-439. 被引量:1
  • 5Mansouri Taleghani B,Manke F,Langer R. Changes in blood rheology and microcirculation after preparatory combined thrombocytapheresis and plasmaphresis[J].Beitrage zur Infusionstherapie und Transfusionsmedizin,1997.123-127. 被引量:1
  • 6Blajchman MA,Bordin JO,Bardossy L. The contribution of the haematocrit to thrombocytopenic bleeding in experimental animals[J].British Journal of Haematology,1994,(02):347-350. 被引量:1
  • 7Anders MJ,Lifeso RM,Landis M. Effect of preoperative donation of autologous blood on deep-vein thrombosis following total joint arthroplasty of the hip or knee[J].Journal of Bone and Joint Surgery-American Volume,1996,(04):574-580. 被引量:1
  • 8Dietrich G,Kretschmer V,Orth D. Primary hemostasis in hemodilution-1 Hemocrit[J].Infusion therapy and Transfusion Medicine,1990,(04):212-213. 被引量:1
  • 9Valeri CR,MacGregor H,Cassidy G. Effects of temperature on bleeding time and clotting time in normal male and female volunteers[J].Critical Care Medicine,1995,(04):698-704. 被引量:1
  • 10Cabibbo S,Garozzo G,Antolino A. Continuous improvement of our autologous blood donation program carried out during 10 years in 1198 orthopaedic patients[J].Transfusion and Apheresis Science,2009,(01):13-17. 被引量:1

二级参考文献78

  • 1Prevention of venous thrombosis and pulmonary embolism: NIH Consensus Development. JAMA, 1986, 256:744-799. 被引量:1
  • 2Weinmann E, Salzman EW. Deep-vein thrombosis. New England J Med, 1994,331:1630-1641. 被引量:1
  • 3Warwick D, Williams MH, Bannister GC. Death and thromboembolic disease after total hip replacement A series of 1162 cases with no routine chemical prophylaxis. J Bone Joint Surg Br, 1995,77:6-10. 被引量:1
  • 4Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines. Chest, 2008,133(Suppl): $381-453. 被引量:1
  • 5Murray DW, Britton AR, Bulstrode C J, et al Thrombo- prophylaxis and death after total hip replacement. J Bone and Joint Surg, 1996,78:863-870. 被引量:1
  • 6Fender D, Harper WM, Thompson JR, et al. Mortality and fatal pulmonary embolism after primary total hip replacement: results from a regional hip register. J Bone Joint Surg Br, 1997,79:896-899. 被引量:1
  • 7Della Valle AG, Serota A, Go G, et al. Venous throm- boembolism is rare with a multimodal prophylaxis protocol after total hip arthropasty. Clin Orthop, 2006, 444:146-153. 被引量:1
  • 8Cusick LA, Beverland DE. The incidence of fatal pulmonary embolism after primary hip and knee replacement in a consecutive series of 4253 patients. J Bone Joint Surg Br, 2009,91:645-648. 被引量:1
  • 9Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anesthesia: results from overview of randomized trials. BMJ, 2000,321:1493. 被引量:1
  • 10Dorr LD, Genlelman V, Maheshwari AV, et al. Multomodal thromboprophylaxis for total hip and knee arthroplasy bated on risk assessment. J Bone Joint Surg Am, 2007,89:2648-2657. 被引量:1

共引文献396

同被引文献29

  • 1Meadows TA,Bhatt DL. Clinical aspects of platelet inhib- itors and thrombus formation[J]. Circ Res, 2007,100(9): 1261-1275. 被引量:1
  • 2Goldhaber SZ,Tapson VF. DVT FREE Steering Commit- tee. A prospective registry of 5 451 patients with ultra- sound-confirmed deep vein thrombosis[J]. Am J Cardiol, 2004,93(2) :259- 262. 被引量:1
  • 3Bell E J, Selvin E, Lutsey PL, et al. Glycemia (hemoglobin Alc) and incident venous thromboembolism in the Ather- osclerosis Risk in Communities cohort study [J]. Vasc Med,2013,18(5) :245-250. 被引量:1
  • 4Angehaisuksiri P. Venous thromboembolism in Asia-an unrecognised and unde>treated problem? [J]. Thromb Haemost, 2011,106 (4) : 585-590. 被引量:1
  • 5Brose K,Bland KS,Wang KH,et al. Slit proteins bind Robo receptors and have anevolutionarily conserved role in repulsive axon guidance[J]. Cell, 1999,96(6): 795-806. 被引量:1
  • 6Morlot C, Thielens NM, Ravelli RB, et al. Structural in- sights into the Slit-Robo complex[J]. Proc Natl Acad Sei U S A,2007,104(38) :14923-14928. 被引量:1
  • 7Patel S,Reheman A. The cell motility modulator slit2 is a potent inhibitor of platelet function[J]. Circulation, 2012, 126(11) :1385-1395. 被引量:1
  • 8Tole S,Mukovozov IM, Huang YW, et al. The axonal re- pellent, Slit2, inhibits directional migration of circulating neutrophils[J]. J Leukoc Biol,2009,86(6) :1403-1415. 被引量:1
  • 9Licht C, Pluthero FG, Li L, et al. Platelet-associated com- plement factor H in healthy persons and patients with a- typical HUS[J]. Blood,2009,114(20) :4538- 4545. 被引量:1
  • 10Abou-Saleh H, Yacoub D, Theoret JF, et al. Endothelial progenitor cells bind and inhibit platelet function and thrombus formation[J]. Circulation, 2009,120(22) : 2230- 2239. 被引量:1

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