老年股骨粗隆间骨折围手术期总失血量与手术显性出血量的关系

Correlation between Perioperative Total Blood Loss and Surgical Dominant Blood Loss in Elderly Patients with Fractures of Femurs Haft

目的探讨老年股骨粗隆间骨折患者行股骨近端防旋髓内钉(PFNA)固定围手术期总失血量与手术显性出血量间的关系,以全面评价手术损伤。方法收集我院骨外科2008年1月—2011年12月行PFNA内固定的老年股骨粗隆间骨折58例,分析围手术期失血量与年龄、性别、身高、体重、手术时间、手术显性出血量、手术前后血红蛋白(Hb)变化值、手术前后红细胞压积(HCT)变化值的相关性。结果 Spearman相关性检验显示围手术期总失血量与身高、体重、手术时间、手术显性失血量、手术前后Hb变化值及手术前后HCT变化值均呈正相关(P均<0.05);以这6项指标行逐步多元线性回归分析,得出以手术时间(T)、手术显性失血量(S)、手术前后Hb变化值(HbC)及手术前后HCT变化值(HCTC)构建的最佳回归方程:围手术期总失血量=0.38×T+0.42×S+0.67×HbC+0.79×HCTC+643.21。结论不宜单独以手术显性失血量反映老年股骨粗隆间骨折患者围手术期总失血量,应将手术时间及手术前后Hb、HCT变化值一同纳入手术损伤评价体系。

Objective To explore correlation between perioperative total blood loss and surgical dominant blood loss in eleterly patients with fractures of femurs haft who underwent proximal femoral nail antirotation （PFNA） fixation. Methods Fifty-eight patients with fractures of femurs haft during January 2008 and December 2011 underwent proximal femoral nail antirotation （PFNA） internal fixation. The correlation between blood loss volume in perioperative period （BLQPP） and age, gender, height, weight, the operation time, the surgical dominant blood loss volume, the changes of hemoglobin （Hb） and haematoerit （HCT） before and after operation were analyzed. Results Spearman rank correlation test showed that there were positive correlations between BLQPP aud height, weight, the operation time （T） , the surgical dominant blood loss volume, the changes of Hb and HCT before and after operation （P 〈0.05）; the operation time （T）, the surgical dominant blood loss volume （S） and the changes of Hb （Hbc） and HCT （HCTC） before and after operation built the best regression equation by gradual multiple linear regression analysis with the above six indexes. The BLQPP was 0.38 ×T ＋ 0.42 ×S ＋ 0.67 ×HbC ＋ 0.79 ×HCTC ＋ 643.21. Conclusion The surgical dominant blood loss volume may not represent the total blood loss volume of perioperative period in elderly patients with fractures of femurs haft. The operation time, the changes of Hb and HCT before and after operation must be taken into account when assessing the evaluation system for operative injuries.