PFNA治疗老年股骨粗隆间骨折隐性失血量相关性分析

Correlation between the Total Blood Loss and the Hidden Blood Loss during Different Periods after PFNA Surgery for Intertrochanteric Fractures in Elderly Patients

目的：探讨股骨近端防旋髓内钉（ proximal femoral nail antirotation，PFNA）治疗老年股骨粗隆间骨折围手术期阶段性隐形失血量的相关性。方法回顾性分析2010年1月至2012年1月，我院采用PFNA手术治疗老年股骨粗隆间骨折36例患者的临床资料，入选病例均为初次患病，24 h补液量不超过2000 mL，排除严重内科疾病、自身免疫性疾病患者。对术前、术后1 d、3 d、5 d、7 d血常规以及术中、术后出血量，使用Gross方程进行计算，应用方差分析对不同时间段的隐性失血量进行比较（以P〈0.05为标准），同时，探讨总失血量和阶段性隐性失血量变化值的相关性。结果36例患者平均总失血量为（956.82±207.61）mL，其中平均显性失血为（88.08±16.28）mL，占总失血量的9.88%，平均隐性失血为（820.96±164.34）mL，占总失血量的90.23%。1 d阶段性隐性失血量和2~3 d阶段性隐性失血量没有显著性差异，但二者与4~5 d阶段性隐性失血量相比，却有着显著性差异。Pearson相关性检验显示，围手术期总失血量与1 d内阶段性隐性失血量（ r=0.770）、2~3 d阶段性隐性失血量（ r=0.884）、4~5 d阶段性隐性失血量（r=0.589）呈正相关（P〈0.05）。得到最佳线性方程：围手术期总失血量=0.978×1d内阶段性隐性失血＋1.029×2~3 d内阶段性隐性失血＋0.779×4~5 d阶段性隐性失血量＋58.327。结论 PFNA治疗老年股骨转子间骨折术后以隐性失血量为主，主要发生于术后前3 d，应严格监测患者的生命体征和及时复查血常规以减少贫血导致的并发症。

Objective To explore correlation between the total blood loss and the hidden blood loss during different peri-ods after Surgery（ PFNA）for elderly patients′intertrochanteric fractures. Methods A retrospective case series of 36 patients operated between January 2010 and January 2012 was reviewed. All the patients were initial illness,and 24 h infusion volume was not more than 2 000 mL. The patients of serious medical illness and autoimmune-diseases were excluded. According to Gross formula,we calculated the total blood loss with the patients′ height,weight,and Hct during peri-postoperative period, make statistical analyse by analysis variance design in different groups,and analyzed correlation between the total blood loss and the hidden blood loss during different periods. Results The mean total blood loss was（956. 82 ± 207. 61）mL. The mean observed blood loss was（88. 08 ± 16. 28）mL. The mean hidden blood loss was（820. 96 ± 164. 34）mL. About 90. 23% of the total blood loss volume was the hidden blood loss. There were no significant differences in the first day and the first 2~3 day, but were significant with first 4~5 day. Pearson rank correlation test showed that there were positive correlations between the totalblood loss（ Y ）and the hidden blood loss in the first day（ A ）,the first 2 ~3 day（ B ）,and the first 4 ~5 day（ C ）（ P 〈0. 05）. And we built the best regression equation,Y=0. 978＊A＋1. 029＊B＋0. 779＊C＋58. 327. Conclusion The hid-den blood loss was the major part of total blood loss in PFNA for elderly patients with intertrochanteric fractures,especially in the first 3 days. It is very important to supply the blood volume during peri-postoperative period to decrease the risk of compli-cations.