股骨颈骨折全髋关节置换后异体血输注的影响

Influential factors for allogenic blood transfusion after total hip arthroplasty for femoral neck fractures

背景:人工髋关节置换成为目前治疗移位性股骨颈骨折效果较为肯定的方法,因其围手术期失血量较多,致使很多患者需要输血,而输血本身有一定的成本和风险。目的:探讨股骨颈骨折患者全髋关节置换后异体血输注的相关影响因素,进一步指导并完善在临床工作中血液管理。方法:对接受全髋关节置换的275例股骨颈骨折患者进行回顾性分析,比较不同性别、年龄、体质量指数、置换前血红蛋白水平、术中出血量、双下肢静脉血栓、置换后抗凝方式、手术时间、假体类型等对置换后异体血输注的影响,以及对异体血输注的预测价值。结果与结论:比较男性患者与女性患者全髋关节置换后的输血量时发现两者差异无显著性意义(P>0.05),而在输血率方面两者差异具有显著性意义(P<0.05)。两组内体质量指数≤25kg/m2的患者和>25kg/m2的患者在输血量及输血率上组间差异均无显著性意义(P>0.05)。年龄、置换前血红蛋白水平和置换过程中出血量是股骨颈骨折患者全髋置换后异体血输注的影响因素,而性别、体质量指数、抗凝方式、双下肢静脉血栓、手术时间、假体类型及术后引流量对术后异体血输注的影响不大。提示,根据影响因素所建立的模型公式对临床上评估和预测置换后异体血输注的风险具有一定的应用价值。

BACKGROUND：Hip arthroplasty surgery as an effective treatment for elderly displaced femoral neck fractures,because of its greater perioperative blood loss,results in many patients requiring blood transfusion,and the transfusion itself has certain costs and risks.How to reduce postoperative allogeneic blood transfusion in patients has certain social benefits.OBJECTIVE：To investigate the related factors for requirement of allogenic blood transfusion after primary total hip arthroplasty for elderly patients with femoral neck fractures,and to further guide and improve blood management in clinical work.METHODS：Using our hospital database,we retrospectively studied the mean reduction in hemoglobin of 275 consecutive elderly patients with femoral neck fractures who underwent primary total hip arthroplasty.We analyzed the effect of patient age,sex,body mass index,preoperative hemoglobin level,blood loss,deep vein thrombosis,postoperative anticoagulation method,operation time and type of prosthesis on postoperative allogenic blood transfusion rate and volume.RESULTS AND CONCLUSION：There was significant difference for the postoperative allogenic blood transfusion rate between male and female patients（P 0.01）.But the postoperative allogenic blood transfusion volume was similar in two groups（P 0.05）;The postoperative allogenic blood transfusion rate and volume was little higher among the patients whose body mass index was lower（P 0.05）;Age,preoperative hemoglobin level and blood loss impact the allogenic blood transfusion after total hip arthroplasty and sex,body mass index,anticoagulant way,deep vein thrombosis,operation time,prosthesis type and postoperative drainage have little effect on allogenic blood transfusion.The model based on binary linear regression is useful to forecast allogenic blood transfusion after total hip arthroplasty.