同一患者分期行关节置换围置换期失血的比较

Comparison of perioperative blood loss in the same patient undergoing staged joint replacement

背景:围置换期失血是骨科关节置换后常见问题,而置换后隐性失血导致的贫血严重影响了患者的术后功能恢复,相关机制仍不明确,多种因素错综复杂,关联性不清。目的:观察同一患者分期行关节置换后围置换期失血量的变化,避免患者之间的差异性对置换后隐性失血的影响,探讨相关临床指标与隐性失血的相关性。方法:收集解放军南京军区南京总医院不同时期因不同疾病类型行关节置换治疗的患者19例,对同一患者分期关节置换后进行围置换期失血量分析,包括显性失血量、隐性失血量与分期置换间隔时间、疾病类型、置换类型、手术时间、抗凝药物以及置换前后血常规、C-反应蛋白等多个变量的相关性。结果与结论:纳入19例患者分期置换前血红蛋白和红细胞压积值均维持在正常范围,差异无显著性意义。经过统计学分析,发现分期置换患者显性失血量上差异有显著性意义(P<0.05)。对多个变量的相关性进行秩相关和多重线性分析,置换间隔时间与分期置换显性出血量具有显著相关性(P<0.05),置换类型异同及抗凝药异同与分期置换显性出血量和隐性失血量无明显相关性;关节置换后存在严重的隐性失血,隐性失血量与置换前C-反应蛋白水平、置换后C-反应蛋白水平存在显著相关性(P<0.05),与住院时间无显著相关性。结果提示关节置换后存在严重的隐性失血,与个体本身相关,与其他外界变量无直接相关性。若对大样本的同一类型患者进行回顾性或是前瞻性对比观察,对探究隐性失血的发生机制会有重要的意义。

BACKGROUND： Perioperative blood loss is a common problem after orthopedic joint arthroplasty, however, anemia resulting from hidden blood loss has a strong impact on postoperative functional recovery. The related mechanism is still uncertain, numerous factors are complex, and the relevance is not clear. OBJECTIVE： To observe the changes in perioperative blood loss in staged bilateral joint replacement patients, to avoid the influence of the difference among patients on hidden blood loss, and to discuss the relationship between hidden blood loss and related factors. METHODS： A total of 19 patients, who received arthroplasty because of different diseases at different periods in Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA, were enrolled in this study. Perioperative blood loss was analyzed in the same patient after staged bilateral joint replacement, including the correlation among dominant blood loss, hidden blood loss, staged surgery interval, disease type, kinds of surgery, length of operation, anticoagulant, regular blood detection after replacement and C-reactive protein. RESULTS AND CONCLUSION： Preoperative values of hemoglobin and hematocrit in 19 patients were in the normal range, and no significant difference was detectable. By means of statistical analysis, significant difference on dominant blood loss was detected in staged surgery （P 〈 0.05）. Correlation between many variables was analyzed using rank correlation and multiple regression analysis. There was significant correlation between staged surgery interval and dominant blood loss （P 〈 0.05）. No obvious correlation was found between replacement type, anticoagulant and dominant blood loss, hidden blood loss. Severe dominant blood loss and hidden blood loss after replacement were significantly correlated with preoperative and postoperative C-reactive protein levels （P 〈 0.05）, but not associated with length of stay. Above data suggested that severe hidden blood loss existed after replacement, which was associated with the individual, but not directly correlated with other external variables. If we make a comparative study in the large sample and same type of patients by retrospective or prospective methods, it will make a contribution to exploring the mechanism of hidden blood loss.