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目的:探讨不同输血策略对老年髋关节置换患者预后的影响。方法:选择2012-03-2015-05住院的老年髋关节置换术患者236例,年龄60~78岁,按美国麻醉医师协会(ASA)分为Ⅰ~Ⅲ级。根据不同输血指征将患者分为对照组117例(Hb<100g/L输血)与限制性输血组119例(Hb<80g/L输血)。比较2组性别比、年龄、体重、ASA分级、术前Hb等一般资料;观察2组输血前后Hb水平、术中羟乙基淀粉及红细胞输注量、术中低血压及住院时间;记录并比较2组术后并发症发生率。结果:1限制性输血组输血前后Hb水平、红细胞输注量明显低于对照组(P<0.05),而羟乙基淀粉输注量、术中低血压发生率明显高于对照组(P<0.05),2组住院时间差异无统计学意义(P>0.05);2限制性输血组肺炎发生率明显低于对照组(P<0.05),而肺栓塞、伤口感染、心力衰竭、脑梗死、病死率等指标与对照组比较差异无统计学意义(P>0.05)。结论:实施限制性输血策略可减少输血量,且不增加患者的术后并发症,不延长住院时间,对预后不会产生不良影响。
Objective: To investigate the effect of different transfusion strategies on the prognosis of elderly patients with hip replacement. Methods: A total of 236 elderly patients aged 60 to 78 years who underwent hospital admission for hip arthroplasty were selected from March 2012 to May 2015. The patients were divided into Ⅰ ~ Ⅲ grade according to American College of Anesthesiologists (ASA). Patients were divided into control group of 117 cases (Hb <100g / L transfusion) and restricted transfusion group of 119 cases (Hb <80g / L transfusion) according to different transfusion indications. The data of sex, age, body weight, ASA grade and preoperative Hb were compared between two groups. Hb levels, intraoperative hydroxyethyl starch and erythrocyte transfusion, intraoperative hypotension and hospital stay were observed before and after transfusion. The incidence of postoperative complications was compared between the two groups. Results: The level of Hb and the amount of erythrocyte transfusion in the restricted transfusion group were significantly lower than those in the control group (P <0.05), while the volume of hydroxyethyl starch infusion and the incidence of intraoperative hypotension were significantly higher than those in the control group (P < 0.05). There was no significant difference in the length of hospital stay between the two groups (P> 0.05). The incidence of pneumonia in the 2 transfusion group was significantly lower than that in the control group (P <0.05), but pulmonary embolism, wound infection, heart failure, There was no significant difference in mortality and other indicators between the two groups (P> 0.05). Conclusion: The implementation of the restrictive blood transfusion strategy can reduce the amount of blood transfusion, and does not increase the postoperative complications of patients, do not extend the hospital stay, the prognosis will not have an adverse effect.