老年髋部骨折围手术期失血量的临床观察

Perioperative blood loss in elderly hip fracture

目的通过观察髋部骨折围手术期血红蛋白水平改变,总结髋部骨折患者围手术期隐形失血量、总失血情况,探讨围手术期失血量的危险因素。方法选择北京市顺义区医院骨科2011年12月至2013年12月老年髋部骨折患者,记录患者一般情况,包括性别、年龄、并发症、骨折类型,手术方式(分别按照空心钉、关节置换、动力性髋螺钉和髓内钉的标准流程操作)、抗凝药物使用情况、出血量、手术时间等,根据患者血红蛋白水平波动、输血量计算患者隐形失血量、总失血量,通过方差分析及多因素线性分析计算围手术期间总失血量的独立危险因素。结果 2011年12月至2013年12月共有161例老年髋部骨折患者入选,经单因素方差分析及多因素线性回归分析,发现服用抗凝药物(均P=0.000)、手术方式(P=0.000,P=0.004)是围手术期出血量较多的独立危险因素。结论老年髋部骨折围手术期隐形失血量远远大于术中出血量,髓内钉术中出血量较关节置换、动力性髋螺钉(DHS)系统少,但隐形失血量、总失血量较其他三种手术方式明显增多,此外,服用阿司匹林等抗凝药物可增加术中出血量、隐形失血量及总失血量。

Objective To observe the dynamic hemoglobin level of perioperative in elderly hip fracture; to conclude the perioperative hidden blood loss and total blood loss; to determine the risk factor on the perioperative total blood loss in elderly hip fracture. Methods The patients with elderly hip fracture general conditions,etc age,gender,fracture type,surgery type（ holow screw,knee arthroplasty,dynamic hip screw,proximal femoral naill anti-rotation）,during for operation,hidden blood loss,total blood loss,were recorded from Dec 2011 to Dec 2013. The total blood loss was calculated on the basis of the haemoglobin difference,and the number of transfusions. The univariate ANOVA and Multivariate linear regression analysis were performed to identify independent factors associated with total blood loss in elderly hip fracture. Results One hundred and sixty one elderly hip fracture patients were enrolled in the study.The type of surgery（ P = 0. 000,0. 004）,and treatment with anticoagulation（ all P = 0. 000） were all independent predictors of blood loss through the ANOVA and Multivariate linear regression analysis.Conclusions The hidden blood loss after surgery for hip fracture was much greater than that observed intraoperative blood loss in all patients. The intramedullary nail had lesser intra-operative blood loss compared with joint replacement and dynamic hip screw,but the hidden blood loss and total blood loss were much more than other three kinds of operations. In addition aspirin anticoagulant drugs can increase the amount of bleeding,hidden blood loss and total blood loss.