老年患者腰椎椎间融合术围手术期应用不同自体血回输方式的有效性研究

摘要

Objective:To retrospectively study the effectiveness of perioperative application of autologous blood transfusion in elderly patients with lumbar interbody fusion.Methods:Elderly patients treated with spinal interbody fusion in our department from Jan 2008 to Dec 2016 were collected and were divide into four groups:the pure autologous blood transfusion group(n=48),the autologous blood and intraoperative transfusion group (n=26),the autologous blood and postoperative transfusion group(n=64) and the autolo-gous blood and intraoperative and postoperative transfusion group (n=29) according to different perioperative blood transfusion meth-ods.The preoperative and postoperative blood samples test and postoperative adverse reactions were compared among the groups.Re-sults:There was no significant difference in the blood samples test results before operation (P>0.05),and there was no significant difference in the indexes levels of HGB,HCT,PT and APTT among groups at 1 week after operation(P>0.05),but there were overall differences in the WBC level after operation (P<0.05),and there were statistically significant differences in the WBC level between the pure autologous blood transfusion group and other three groups at 1 week after operation(P<0.01).There was no hemolysis,renal failure,severe sepsis and other severe blood transfusion related adverse reactions during transfusion process in patients,and the inci-dence rates of rash and hypothermia in the three groups were lower than those in the pure autologous blood transfusion group (P<0.05).Conclusion:Autologous blood,intraoperative and postoperative transfusion is a good perioperative treatment plan,and it is wor-thy of widely application in elderly spinal fusion surgery.%目的:回顾性研究老年患者腰椎椎间融合术围手术期应用不同自体血回输方式的有效性.方法:收集行脊柱椎间融合手术的老年患者167例,根据围手术期输血方式不同将患者分为4组:单纯自体血回输组(n=48)、自体血+术中回输组(n=26)、自体血+术后回输组(n=64)、自体血+术中回输+术后回输组(n=29),对比各组手术前后抽血检查情况及术后不良反应情况.结果:各组术前抽血检查结果比较差异均无统计学意义(P>0.05),术后1周各组HGB、HCT、PT、APTT指标比较差异亦无统计学意义(P>0.05),但术后WBC水平存在总体差异有统计学意义(P<0.05),自体血+术中回输组、自体血+术后回输组、自体血+术中回输+术后回输组术后1周WBC与单纯自体血回输组比较差异均有统计学意义(P<0.01);所有患者输血过程中,均未出现溶血、肾衰竭、严重感染败血症等严重输血相关不良反应,自体血+术中回输组、自体血+术后回输组、自体血+术中回输+术后回输组皮疹及低体温反应发生率低于单纯自体血回输组,差异存在统计学意义(P<0.05).结论:采用自体血+术中回输+术后回输是一种良好的围手术期处理方案,值得在老年脊柱融合手术中广泛开展.