在初级全关节置换术后发生异常的术后血液检查的发生率和危险因素
Georgios Orfanos1, Nakulan Nantha Kumar2,3, Daniel Redfern1
1The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK.
Bone & joint open
|November 23, 2023
概括
整体关节置换 (TJR) 后的常规术后血液检查往往没有益处. 临床医生应确定高风险患者进行向测试,以管理潜在的贫血和急性损伤 (AKI).
科学领域:
- 整形外科手术 整形外科手术
- 临床病理学 临床病理学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 在整体关节置换 (TJR) 后,术后监测至关重要.
- 在TJR患者中,例行术后血液检查的实用性需要评估.
- 重要的是要确定异常结果的危险因素,例如贫血和急性损伤 (AKI).
研究的目的:
- 评估TJR患者手术后异常血液检测结果的发生率.
- 确定与异常的术后血液检查相关的术前风险因素,特别是贫血和AKI.
- 为了确定在这个人群中例行术后血液检查的整体有用性.
主要方法:
- 对2721名接受选择性TJR的患者进行了回顾性队列研究.
- 数据收集包括人口统计,美国麻醉学会 (ASA) 级别,以及全面的手术前/手术后实验室值.
- 分析的重点是异常的血液检测,AKI,电解质失衡,贫血和一年内的临床结果.
主要成果:
- 在16.3%的患者中发现异常的术后血液测试.
- 测试异常的风险因素包括年龄 (≥65岁),女性性别和ASA等级≥III.
- 手术前低血红蛋白/血红素预测贫血;低预测AKI.
结论:
- 在TJR患者的常规术后血液检查通常不会超过其成本.
- 临床医生应实施风险分层,重点关注患有异常手术前血红蛋白,显著血损失,慢性病,高ASA等级或临床关注的患者.
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