老年患者转子间骨折术后血容量变化与急性精神障碍

Blood Volume Changes and Acute Mental Disorders of Post Intertrochanteric Fracture in Elderly Patients

目的研究老年股骨转子间骨折患者手术前后血容量的变化与处理原则。方法回顾性分析我院2007年1月～2009年10月应用闭合复位股骨近端髓内钉内固定治疗股骨粗隆间骨折60例,根据患者身高、体重、平均红细胞压积、手术前后的红细胞压积变化,通过Cross方程推算出骨折及术后的出血量。结果术前平均失血(695.85±199.24)mL,术前可诊断贫血患者占40%(24/60);术后患者均明显出现血红蛋白降低,平均降低(18.22±10.66)g/L,围手术期平均失血量(952.37±205.24)mL,术后可诊断为贫血患者66.67%(40/60)。术后共输血19例;共出现急性精神障碍27例,占45%(27/60)。结论转子间骨折患者手术前后失血量大,且老年患者对失血的耐受性差,与急性精神障碍具有相关性。正确地评估失血量、及时处理失血性贫血,有利于提高手术的安全性与机体的康复。

Objective To investigate the changes of blood volume and the treatment principles before and after the surgery of intertrochanteric fracture in elderly patients. Methods Sixty cases of intertrochanteric and subtrochanteric femoral fractures treated with close reduction of the proximal femoral nail in our hospital from January 2007 to October 2009 were retrospectively analyzed. Accord- ing to the patients＇ height, weight,MCV and the changes of MCV before and after the surgery, the amounts of bleeding in the frac- ture and after the operation were figured out by using Cross equation. Results Before the operation, the average amount of bleeding was （695.85 ± 199.24）mL,and 40% of the patients were diagnosed as anemia. After the operation, all the patients＇ Hb amounts decreased in an average of （18.22 ± 10.66）g/L. In perioperative period, the average amount of bleeding was （952.37 ±205.24）mL. Meanwhile, 66.67%（40/60） patients were diagnosed as anemia after operation. There were 19 cases of blood transfusion, and 27 cases had acute mental disorders after the operation, which was 45%（27/60） of all the patients. Conehlsion The amounts of bleeding before and after operation are huge, and the elderly patients have poor tolerance to blood loss which is relevant to the acute mental dis- orders. Consequently, to assess the amount of bleeding accurately, and to treat the hemorrhagic anemia in time are propitious to improve surgical safety and the rehabilitation of the body.