输血对老年股骨粗隆间骨折隐性失血的影响

Blood Transfusion in Elderly Intertrochanteric Fractures and It's Influence on the Perioperative of the Hidden Blood Loss

目的探讨输血治疗是否是老年股骨粗隆间骨折围手术期隐性失血量的影响因素,并为是否需要输血治疗提供参考。方法回顾性分析2009年3月至2012年10月期间接受股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定手术的176例老年股骨粗隆间骨折患者的临床相关资料,依据是否接受输血治疗将患者分为输血组(56例)及未输血组(120例),对两组患者术前、术后血常规指标以及根据Gross线性方程计算得到的总失血量、隐性失血量进行分析,比较输血治疗对隐性失血量的影响。结果输血组平均隐性失血量为353.0 mL,占平均总失血量比例为83.1%,未输血组患者平均隐性失血量为427.0 mL,占总失血量比例为84.6%。两组平均隐性失血量相比,有统计学意义(P<0.05),平均隐性失血量占总失血量比例,两组比较无统计学意义(P>0.05)。结论输血治疗能减少围手术期隐性失血量,但并不能降低老年粗隆间骨折的隐性失血量占总失血量的比例,术后应根据红细胞压积(hematocrit,Hct)及血红蛋白量(hemoglobin,Hb)的变化,合理选择输血治疗,减少并发症的产生。

Abstract：Objective To explore whether blood transfusion in elderly intertrochanteric fractures is an influencing factor on the perioperative hidden blood loss. To supply reference for the blood transfusion indications and practice. Methods We retrospectivily analyzed data of 176 cases,from March 2009 to October 2012. All intertrochanteric fracture patients were fixed with the proximal femoral nail anti-rotation （PFNA）. The patients were devided into blood transfusion group （56 cases） and no blood transfusion group （120 cases）, the preoperative and postoperative blood exam and intraoperative and postoperative bleeding were recorded and analyzed to get the dominant and recessive bleeding perioperatively. Results The blood transfu- sion group had an average recessive blood loss for 353 mL, the ratio between average hidden blood loss and total blood loss was 83.1% , no blood transfusion group had an average hidden blood loss for 427 mL, and the ratio between average hidden blood loss and total blood loss was 84.6%. The comparision of average hidden blood loss between two groups showed statistical sig nificance （ P 〈 0. 0 5 ） , but the ratio of average hidden blood loss to total blood loss showed no significance different （ P 〉 0.05）. Conclusion Blood transfusion may reduce the Perioperative hidden blood loss, but not the ratio between average hid- den blood loss and total blood loss. Reasonable choice of blood transfusion is based on peristoperative change of red blood cell hemocrit （HCT） and the hemoglobin （Hb） ,which may reduce the complications of surgeries.