老年股骨粗隆间骨折手术隐性失血的危险因素分析

Blood loss in the surgery of elderly femoral intertrochanteric fracture: An analysis on risk factors of hidden loss

[目的]探讨老年股骨粗隆间骨折手术治疗中影响隐性失血量的相关危险因素,提高对隐性失血的认识,为临床股骨粗隆间骨折围手术期治疗提供参考。[方法]回顾性分析本院2009年1月~2014年10月205例股骨粗隆间骨折患者临床资料,其中符合纳入标准,并获得完整病史资料有115例。隐性失血量通过手术前后红细胞压积变化,使用Gross方程,根据身高、体重和手术前后的红细胞压积（HCT）变化计算获得,对患者性别、年龄、是否存在基础疾病（高血压、糖尿病）、骨折类型、内固定方式、麻醉方式,受伤至手术时间,术前6个月内是否服用抗血小板药物,术后使用抗凝药物进行统计分析,筛选出差异有统计学意义的因素,然后以隐性失血量为因变量,以各影响因素为自变量,进行多元线性回归分析隐性失血的危险因素。[结果]患者术中显性失血量为（210.12±171.34）ml,隐性失血量为（583.19±117.54）ml。单因素分析结果显示,不同内固定方式、骨折类型、麻醉方式、术前使用抗血小板或术后使用抗凝药物隐性失血量差异显著（P≤0.05）,多重线性回归分析结果显示,对隐性失血量有显著影响的因素有内固定方式、骨折类型、麻醉方式、抗凝药物应用。[结论]隐性失血是老年股骨粗隆间骨折手术失血的主要原因,造成隐性失血的危险因素有内固定方式、骨折类型、麻醉方式、抗凝药物运用;临床治疗中,将显性失血量作为补液、输血的依据不可靠,要充分考虑隐性失血的存在,应尽早干预,预防并发症发生。

[ Objective ] The associated risk factors influencing the hidden loss of blood during the surgery of elderly femoral intertrochanteric fractures was investigated in this paper, so as to improve the understanding of hidden blood loss, meanwhile pro- vide references for clinical practices. [ Method] Data from 205 cases of elderly femoral intertrochanteric fractures in our hospital from January 2009 to October 200d were analyzed retrospectively, of which 115 cases met the inclusion criteria and complete ma- terials of their medical history was obtained. The change of patient＇s body height,body weight and the change of Hct before and after surgery were caulculated using Gross formula to get the amount of hidden blood loss. In the following statistic analysis pro- cedure, independent variables included the gender, age, underlying diseases （ hypertension, diabetes）, the type of fracture, inter- nal fixation, anesthesia, the time from injury to surgery, whether taking anti - platelet drugs within six months before preoperation and postooerative anticoagulation. Subsequently, those independent variables were combined with hidden blood loss as dependent variable for multiple linear regression analysis,in order to find out the risk factors. [ Result]The overt blood loss was （210.12 ± 171.34 ） ml, the hidden loss of blood was （ 583. 19 ± 117.54 ） ml. One - way ANOVA analysis showed that significant differ- ences were found from internal fixation types,fracture type, anesthesia, use of antiplatelet before surgery or use of coagulating drug after surgery （P ≤0.05 ）, the muhipe linear regression analysis showed that risk factors included internal fixation ,fracture type, anesthesia and the use of coagulating drug. [ Conclusion ] The hidden blood loss is the main reason for gross blood loss in elderly femoral intertrochanteric fractures surgery. The risk factors include internal fixation,fracture type, anesthesia and the use of coagulating drug. Therefore,during the clinical surgery,it＇s unreliable to take the overt blood loss as the measure standard for transfusion and blood transfusion. The hidden blood loss should be taken consideration and prevented early,so as to avoid post- operative complications.