单侧初次人工全髋关节置换术后隐形失血的初步分析

Preliminary analysis of hidden hemorrhage after primary unilateral total hip arthroplasty

目的分析初次人工全髋关节置换术（totalhip arthroplasty，THA）后隐性失血的情况并提出处理对策。方法回顾性分析2009年1月一2011年1月采用THA治疗单侧需要进行初次置换的髋部疾病138例患者，其中男48例，女90例；年龄45-71岁，平均62岁。对患者术前、术后血常规及术中、术后出血、输血情况进行分析，对患者围术期隐性出血情况进行评估。结果本组138例患者全部进行术中自体血回输，术中出血量（495±105）ml，术后引流量（121±29）ml，其中116例术后另予输红细胞悬液及血浆以提高血色素水平，输红细胞悬液量（600±225）ml。本组总失血量（1521±156）ml，隐性失血量（822±96）ml，隐性失血量占总失血量57．2％。各指标男女间差异均无统计学意义。结论隐性失血是影响进行THA患者预后的一个重要因素，进行此类手术评估出血量时应充分考虑到隐性失血量，及时采取相应的处理措施充分有效地恢复患者有效循环血量，以保证围术期安全度过，以利患者的康复。

Objective To analyze the hidden blood loss following primary total hip arthroplasty （THA） and put forward corresponding treatment measures. Methods A retrospective study was done on the 138 patients with hip disease managed with THA for the preliminary unilateral replacement from January 2009 to January 2011. There were 48 males and 90 females, at age range of 45-71 years （ mean, 62 years）. The pre-and post-operative blood routine and intra-and post-operative blood loss and transfusion were ana- lyzed and hidden blood loss during peri-operation period was evaluated. Results All the patients Were transfused with autologous blood intra-operatively. Intra-operative blood loss was （495 ±105） ml and post- operative drainage volume was （121±29） ml. In addition, 116 patients were given red cell suspension （RCS） and blood plasma to raise the level of hemoglobin and the RCS transfusion volume was （600 ± 225） ml. The total blood loss was （1 521±156） ml including hidden blood loss of （822±96） ml （57.2%）. No obvious differences were observed in the indicators between males and females. Conclu- sions Hidden blood loss is an important factor that affects the prognosis of the patients treated by THA. In order to secure their safety in perioperative period and benefit their recovery, assessment of the amount of bleeding in THA should fully take the hidden blood loss into consideration and prompt treatment measures should be taken to fully and effectively recover their effective circulation blood volume.