老年人营养状况对股骨颈骨折术前隐性失血的影响

Correlation between preoperative hidden blood loss and nutritional status in elderly femoral neck fracture patients

[目的]明确老年股骨颈骨折患者入院时营养状况对术前隐性失血的影响。[方法]纳入345例获得完整随访的股骨颈骨折患者进行分析,平均年龄77.71岁,均为新鲜初次股骨颈骨折;根据MNA评分分为营养正常组、潜在营养不良组和营养不良组,根据身高、体重、入院时和术前红细胞压积,计算术前血容量和隐性失血量,按照术前隐性失血量占术前血容量比例将患者分为低和高隐性失血量组。比较两组间术前隐性失血量及其占术前血容量的比例和术前高隐性失血发生率是否有差异,分析术前营养状况与术前高隐性失血之间的关系。[结果]共90例患者发生高隐性失血,术前隐性失血量平均166.40 ml,术前隐性失血量占术前血容量的平均比例为4.04%。其中营养正常组术前隐性失血量及其占术前血容量的比例分别为120.10 ml和2.87%,高隐性失血发生率为14.13%(13/92例);潜在营养不良组为158.98 ml和3.86%,高隐性失血发生率为25.62%(31/121例);营养不良组为200.41 ml和4.92%,高隐性失血发生率为34.85%(46/132例)。营养不良和潜在营养不良患者术前隐性失血量及其占术前血容量比例和高隐性失血发生率均明显高于营养正常患者,各分组两两间比较,差异均有统计学意义(P<0.05)。[结论]老年股骨颈骨折患者术前隐性失血量及其占术前血容量的比例和高隐性失血发生率均随着营养状况的恶化而逐渐升高;营养状况是术前隐性失血发生的重要影响因素,可作为判断高隐性失血和预后的重要指标。

[Objective]To observe the effects of preoperative nutritional status on preoperative hidden blood loss（ HBL）.[Method]A total of 345 elderly patients aged 70-92 years（ mean,77. 71） with fresh and initial femoral intertrochanteric fracture were included. Laboratory serological examinations at admission and preoperation were completed. By mini nutritional assessment（ MNA）,patients were randomly divided into three groups： normal-nourishment group,malnourishment at risk group,malnourishment group. The original blood volume and preoperative HBL were calculated depending on height,weight,Hct at admission and preoperation. According to the proportion of mean preoperative HBL on the original blood volume,patients were divided into low and high HBL group. Then,we analyzed the relationship among the preoperative incidence of high HBL,the preoperative HBL and their proportion on the original blood volume,and analyzed the correlations between preoperative high HBL and preoperative nutritional status. [Result]Ninety of 345 cases were found to have high HBL,the mean preoperative HBL was 166. 40 ml,4. 04% of the original blood volume. In normal-nourishment group,the mean preoperative HBL was 120. 10 ml,2.87% of the original blood volume,the prevalence of high HBL was 14. 13%（ 13 /92 cases）. In malnourishment at risk group,the mean preoperative HBL was 158. 98 ml,3. 86% of the original blood volume,the prevalence of high HBL was 25. 62%（ 31 /121cases）. In malnourishment group,the mean preoperative HBL was 200. 41 ml,4. 92% of the original blood volume,the prevalence of high HBL was 34. 85%（ 46 /132 cases）. The preoperative HBL and their proportion on the original blood volume,and the preoperative incidence of HBL in malnourishment at risk group and malnourishment group were obviously higher than that in normal- nourishment group,there were significant differences between any two groups（ P 〈 0. 05）. [Conclusion]The preoperative HBL and their proportion on the original blood volume,and the preoperative incidence of HBL in elderly femoral neck fracture patients are gradually increased with the deterioration of nutritional status. The nutrition status has significant value in predicting the risk of preoperative high hidden blood loss and could be considered as important indicators for judging high hidden blood loss and patient’s prognosis.