| Objective: Intraoperative warming transfusion and infusion has been as a clinicalroutine to prevent the occurrence of perioperative hypothermia. Studies have comfirmedthat intraoperative heating methods can increase the risk of postoperative cognitivedysfunction. This study was designed to investigate the effects of warming bloodtransfusion on early stage of post-operative quality recovery by comparing the early stageof post-operative recovery issues assessed in patients undergoing knee or hip arthroplastywith warming blood transfusion or not.Methods: ASA I-III patients who needed infusion of more than2U allogeneic blood(PRBC), undergoing elective knee or hip arthroplasty by general aneasthesia in ourprospective study, were randomly divided into warming blood transfusion group andcontrol group according to the principle of1:1. Warming blood transfusion group weregiven the infusion of blood warmed up to37℃by water bath heating device in a form ofperipheral intravenous drip at the rate of15ml/min when30min before surgery completed.Control group were given the infusion of blood placed at room temperature (18-21℃) for15-20min in a form of peripheral intravenous drip at the rate of15ml/min when30minbefore surgery completed. Evaluate physiology (including systolic blood pressure, heartrate, temperature, respiratory rate, oxygen saturation, airway control, agitation, conscious-ness and response), nociception (including pain and nausea), emotion (including depre-ssion and anxiety), activities of daily living (including ability to stand, walk and dress without assistance, and ability to eat and drink), cognitive function (orientation, verbalmemory, executive functioning, attention, and concentration) by Post-operative QualityRecovery Scale during preoperation (T0),15min after extubation (T15),40min afterextubation (T40),1d after operation (D1),3d after operation (D3) and7d after operation(D7). Calculate and compare score of post-operative recovery issues and the total rate ofrecovery and occurrence at each time after operation of testing between two groups.Compare the level of quality recovery score at each time after operation of testing betweentwo groups. The changes of nasopharyngeal temperature before induction of anesthesia(T0), before blood transfusion (T1), immediately after blood transfusion (T2),30min afterblood transfusion (T3),1h after blood transfusion (T4),2h after blood transfusion (T5)were monitered and recorded respectively. Compare two groups of patients withintraoperative clinical issues including operation time, anesthesia time, intraoperative inputand output volumn and postoperative clinical issures including postoperative drainage, postanesthesia care unit (PACU) stay time, hemodynamic change, blood routine examination,blood coagulation function, postoperative blood transfusion cases, adverse event incidenceand hospital stay time.Results: One hundred and sixty of patients were included. One hundred and fifty ofpatients completed the trial. Warming blood transfusion group and control group both had75cases. The proportion of good recovery patients in warming blood transfusion groupand control group were4.0%and14.7%. The proportion of moderate recovery patientswere92%and82.7%. The proportion of bad recovery were1.3%and2.7%. There was nosignificant difference of each level distribution between two groups at T15-D7(P>0.05).Compared with control group, patients of warming blood transfusion group had a higherscore value of stand and walk issues at D1(P<0.05). There were no significant differenceof stand and walk issues score value at other time points. Compared with control group, patients of warming blood transfusion group had a lower degree of depression at D7(0%vs8%)(P<0.05). There were no significant difference of feeling issues score value at othertime points. There was no significant difference of physiology recovery rate andnociceptive occurence rate at T15-D7between two groups (P>0.05). There was also nosignificant difference of cognitive function recovery rate at D1-D7(P>0.05). Comparedwith control group, PLT of warming blood transfusion group was higher at D1(P<0.01),and RBC、Hb、HCT of warming blood transfusion group was higher at D7. Compared withcontrol group, SBP of warming blood transfusion group was lower at T40(P<0.05). Therewere no significant difference in suction drainage on6h after operation and total bloodsuction drainage between the two groups, but suction drainage of warming bloodtransfusion group was higher at24h after operation (P<0.05).Conclusion: Warming blood transfusion had no significant effect on earlier post-operative recovery of physiology, activities of daily living and cognitive function, and didnot obviously increase occurence of depression, anxiety, pain and vomit. Warming bloodtransfusion having no significant effect on earlier post-operative quality recovery inpatients undergoing knee or hip arthroplasty might be associated with small amount ofblood transfusion. But introperative warming blood transfusion temperature had anobvious effect on amount of PLT, RBC Hb and HCT. |
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