肥胖对半髋关节置换术围手术期失血的影响

The influence of obesity to perioperative blood loss following hemi-hip arthroplasty

[目的]探讨肥胖对股骨颈骨折患者行人工半髋关节置换术围手术期失血的影响和相关机制。[方法]回顾性研究2008年1月～2010年12月,我科行半髋关节置换术患者69例,其中男33例,女36例,平均年龄(80.4±3.4)岁(75～92岁);左髋30例,右髋39例:肥胖组(BMI>30)36例,非肥胖组(BMI≤30)33例;GardenⅢ型32例,GardenⅣ型37例。所有病例均为初次单侧半髋关节置换的患者,24 h补液总量不超过2 000 ml,通过Gross方程,根据身高、体重和手术前后的红细胞压积(Hct)计算患者的失血总量,减去显性失血量即为隐性失血量。[结果]所有患者平均失血总量为962 ml,其中平均显性失血量308 ml,平均隐性失血量654 ml,显性失血和隐性失血占失血总量的比例分别为32%、68%,隐性失血量远多于显性失血量。肥胖组失血总量平均为1 079 ml,显性失血量平均为349 ml,隐性失血量平均为830 ml。非肥胖组平均失血总量为865 ml,显性失血量为271 ml,隐性失血量为594 ml,两组间比较显性失血量和隐性失血量均有显著性差异。[结论]高龄肥胖患者行半髋关节置换术时,围手术期失血的风险更大,其中隐性失血是主要原因,应注意及时补充血容量,帮助患者安全度过围手术期。

[ Objective ] To explore the influence of obesity to perioperative blood loss following hemi-hip arthroplasty for femoral neck fracture and its mechanism. [ Method] We retrospectively analysised 69 cases performed hemi-hip arthroplasty for femoral neck fracture from Jan. 2008 to Dec. 2010, including 33 males and 36 females, aged 80.4± 3.4 years （ ranging 75 - 92 years）, 30 with left and 39 with right. Obesity group （BMI 〉 30） had 36 cases and normal group （BMI~〈30） had 33 cases. According to Garden classification, there were 32 cases of type Ⅲ ,37 cases of type IV. All the patients were fresh femoral neck fracture following primary hemi-hip arthroplasty,the total influsion volume were less than 2000 ml. According to Gross formulae, we calculated the total blood loss with the patients＇ height,weight and Hct. The perioperative blood loss after surgery including observed blood loss and occult blood loss were analyzed. [ Resnlt]The mean total blood loss was 962 ml,the mean observed blood loss was 308 ml, the mean occult blood loss was 654 ml, each accounted for 32% and 68% in total blood loss, hidden blood loss was much more than observed blood loss. In obesity group the mean total blood loss was 1079 ml, observed blood loss was 349 ml and hidden blood loss was 730 ml,while in the normal group it was 865 ml,271 ml,594 ml each. There were significant difference between the obesity group and normal group. There were more total blood loss and hidden blood loss in obesity group. [ Conclusion] Hid- den blood loss is the major part of total blood loss after hemi-arthroplasty for femoral neck fracture. It is very important to supple- ment the blood volume during perioperative period. The obesity in advanced age is a risk factor for increased blood loss, special attention is in need.