在ERAS框架内同时接受双边直接前部全关节整形手术的年轻成年人中,异构输血的危险因素
Supreet Bajwa1, Ravi Teja Rudraraju2,3, Ponnanna Karineravanda Machaiah4
1Wockhardt Hospitals, Mumbai Central, Maharashtra, India.
Journal of clinical orthopaedics and trauma
|March 9, 2026
概括
由于血红蛋白水平较低,接受双边关节整形手术的年轻印度患者患有股骨头骨 necrosis 经常需要输血. 术前血红蛋白水平为12g/dL被认为是预测和潜在减少输血需求的最佳门.
科学领域:
- 整形外科手术 整形外科手术
- 麻醉学 麻醉学
- 血液学 血液学 血液学
背景情况:
- 在手术后增强恢复 (ERAS) 协议下的同时双边全关节整形术 (SBTHA) 旨在尽量减少出血.
- 年轻的印度患者骨头骨硬化 (ONFH) 经常出现低基线血红蛋白 (Hb),增加输血风险.
- 在接受SBTHA治疗的ONFH患者中,可操作的,队列特定的输血门报告不足.
研究的目的:
- 通过直接前方方法 (DAA) 量化接受SBTHA的年轻ONFH患者的异构输血发生率.
- 在这个特定的患者队列中确定异构输血的独立预测因子.
- 确定一个最佳的手术前Hb值来预测输血需求.
主要方法:
- 根据统一的ERAS协议,对75名连续接受SBTHA-DAA的ONFH患者进行了回顾性审查.
- 分析常规的ERAS协议,包括神经轴麻醉,控制的低血压,松酸,多式止痛和早期动员.
- 后勤回归和接收器操作特征 (ROC) 分析以确定输血预测因素和最佳Hb值.
主要成果:
- 17名患者 (22.7%) 需要全基输血 (共18个单位).
- 输血接受者与非接受者 (13.20 g/dL) 相比,手术前血水平显著降低 (11.46 g/dL).
- 在ROC分析中,11.9g/dL被确定为最优的手术前Hb截止值 (灵敏度94.1%,NPV98%),支持12g/dL的实际值.
结论:
- 在接受ERAS指导的SBTHA-DAA治疗的年轻ONFH患者中,手术前的血红蛋白水平是所有基输血风险的唯一独立预测因素.
- 建议在手术前进行例行贫血查和纠正,以减少这一群体对输血的依赖.
- 确定Hb值为12g/dL可以指导输血决策并优化患者管理.
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