| Objective:To observe the effects of different transfusion methods on the prognosis of elderly patients undergoing orthopedic surgery,such as hemodynamics,immune function,postoperative cognitive function,early rehabilitation quality,postoperative hospital stay,blood transfusion-related costs.To provide clinical reference for the safe and rational use of blood for surgical patients.Methods:To selective 120 case of elective orthopedic surgery who meet the selection criteria,ASAⅡ,aged≥70 years old,and are divided into 4 groups according to different transfusion methods during the operation:no-transfusion group(group A,n=30):no blood transfusion during perioperation period,allogeneic blood transfusion group(group B,n=30):when Hb<8g/d L or Hct<25%,allogeneic blood transfusion,autologous blood transfusion group(group C,n=30):autologous blood transfusion during perioperation period,autologous+allogeneic blood transfusion group(group D,n=30):After autologous blood transfusion,if Hb<8g/d L or Hct<25%,transfusion of allogeneic blood according to the situation.(1)After anesthesia,arterial blood samples were collected for blood gas analysis,use the ABL90FLEX automatic electrolyte blood gas analyzer to detect the Hb and Hct values,and record the changes in hemodynamics,blood loss,allogeneic blood transfusion,autologous blood transfusion,urine volume,operation time and fluid during the operation according to the monitoring results of Vigileo system.(2)Venous blood samples were collected on the before surgery,after surgery,1st,3rd,and5th day after operation and used for flow cytometry to detect the percentage of CD3~+,CD4~+,CD8~+,CD19~+and NK cells.(3)To record the MMSE scores,Qo R-15 scores on the 1st day before surgery,1st,3rd,7th day after surgery,postoperative hospital stay,and blood transfusion-related costs.Results:(1)There was no significant difference in gender,age,body mass,the time of operation,urine volume,crystal fluid volume and colloid infusion of the four groups of patients(P>0.05).Compared with group A,the volume of intraoperative bleeding in group B,group C and group D were increased significantly(P<0.05).Compared with group C,the volume of intraoperative bleeding in group D was increased significantly(P<0.05).(2)Compared with the preoperation,the MAP and HR in group B,group C and group D after the operation were significant reduced(P<0.05).There was no significant difference in the MAP and HR before and after the operation of the four groups of patients(P>0.05).(3)Compared with preoperative,the CD3~+,CD4~+,NK,CD4~+/CD8~+in group B after surgery,1st,3rd,and 5th day after operation were significantly decreased(P<0.05).There was no significant difference in group A,group C and group D(P>0.05).Compared with group A,the CD3~+,CD4~+in group B on the 1st,3rd,and 5th day after operation were significantly decreased(P<0.05).Compared with group B,the CD3~+,CD4~+in group C on the 1st,3rd and 5th day after operation were significantly increased(P<0.05),the CD4~+on the 3rd day and CD3~+on the 5th day in group C after operation were significantly increased(P<0.05).There was no significant difference in the CD8~+,CD19~+on the 1st,3rd,and 5th day after operation in the four groups of patients(P>0.05).(4)Compared with 1st day before operation,the MMSE scores in group A,group C,group D on the 1st day and in group B on the 1st,3rd after operation were significantly decreased(P<0.05).There was no significant difference in MMSE scores in the four groups at each time point(P>0.05).Compared with group A,the Qo R-15 scores in group B and group D on the 1st and 3rd day after operation were significantly decreased(P<0.05),and Qo R-15 score in group C on the 1st day after operation was significantly decreased(P<0.05).Compared with group B,the Qo R-15 scores in group C and group D on the 1st and 3rd day after operation were significantly increased(P<0.05).Compared with group C,the Qo R-15 scores in group D on the 1st and 3rd day after operation were significantly decreased(P<0.05).(5)Compared with group A,the postoperative hospital stay in group B,group C,group D after operation were significantly increased(P<0.05).Compared with group B,blood transfusion-related costs in group C and D were significantly increased(P<0.05),compared with group C,blood transfusion-related cost in group D was significantly increased(P<0.05).Conclusion:Compared with allogeneic blood transfusion,application of intraoperative blood salvage in elderly orthopedic surgery patients can improve the percentage of T lymphocyte subsets and NK cells,and improve postoperative early rehabilitation quality. |
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