| ObjectiveTo study the occurrence mechanism of hidden blood loss and interaction of risk factors by total hip arthroplasty (THA) and total knee arthroplasty (TKA) perioperative blood loss and factors influencing the calculation of assessments, and develop interventions to reduce the amount of hidden blood loss. So a more comprehensive and systematic assessment of total hip and total knee replacement surgery perioperative risk was made.Methods80 cases of all cases of unilateral total hip arthroplasty were collected in our hospital in January 2008 to March 2010, in which 55 cases of femoral head necrosis complicated with osteoarthritis, rheumatoid arthritis in 25 cases, 48 male , 32 female, the youngest was 33 years old, maximum of 80 years, mean age 68 years. 80 patients with unilateral total knee arthroplasty were collected, in which 50 patients with osteoarthritis, rheumatoid arthritis 30 cases, male 40 cases,female 40 cases, the youngest was 45 years old,maximum of 83 years, mean age 72 years . All operations were primary and operated by the same surgical physician using the same surgeon .The rehydration in 24h postoperation was not more than 2000ml. According to height, weight, and hematocrit before and after surgery (Hct), postoperative total blood loss was estimated by Gross formula,and then calculate the amount of hidden blood loss. Records of different ages (70 years for the sector), with or without medical problems (hypertension, diabetes), gender, tourniquet time, between different diseases, obesity (body mass index, BMI≤30 kg / m2 for the non-obese group, BMI> 30 kg / m2 for the obese group) and other cases are made,and study difference in hidden blood loss in THA and TKA. The statistical software SPSS13.0 were statistically analyzed using paired t test, testing standards to takeɑ= 0.05, P <0.05 was statistically significant, comparing the amount of hidden blood loss between the groups in statistics. Analyze mechanism of hidden blood loss and risk factors of THA and TKA and study operative autologous blood transfusion and homologous blood transfusion.ResultsThe actual perioperative total blood loss of 80 patients in THA group averaged 1320 ml, hidden blood loss was 436 ml, 33% of the total, 70 cases of allogeneic blood transfusion rate was 87.5%. The actual perioperative total blood loss of 80 patients in TKA group averaged 1608 ml, hidden blood loss was 828 ml, 51.5% of the total, 56 cases of allogeneic blood transfusion rate was 70%. Hidden blood loss of two groups was compared significantly.The perioperative hidden blood loss of TKA group was more than the THA group. Blood transfusion rate in both groups was no statistical difference. Age, with or without medical illness, gender, tourniquet time dominated significant difference in the amount of hidden blood loss of THA and TKA, indicating that more than 70 years of age, with medical diseases, male, tourniquet time longer led to increase the amount of hidden blood loss .But different diseases and obesity dominated no difference in the amount of hidden blood loss of THA and TKA ,indicating that the rheumatoid arthritis or osteoarthritis ,obesity or not had no effect on perioperative blood loss.ConclusionThe perioperative hidden blood loss of TKA was more than that of THA, especially for the elder, with medical illness, male, and tourniquet time longer , awareness should be raised. Autologous blood transfusion still doesn't fully satisfy the body ,and we should replenish allogeneic blood to prevent complications and ensure medical safety. Strengthening the correct understanding of hidden blood loss can help improve clinical assessment capabilities ,which can help patients survive the perioperative period and be conducive to the early postoperative joint function to carry out training. |
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