全髋关节置换后隐性失血与老年患者营养状况的关系

Correlation between hidden blood loss and nutritional status in elderly patients after total hip replacement

背景:围置换期大量隐性失血的出现可影响全髋关节置换后关节功能恢复。目的:明确老年股骨颈骨折患者入院时微型营养评价法在营养状况评估上的可靠性,探讨老年患者营养状况改变对全髋关节置换后隐性失血的影响。方法:纳入234例股骨颈骨折患者,均采用全髋关节置换治疗;根据微型营养评价法评分将患者分为营养良好组52例、潜在营养不良组92例和营养不良组90例,研究各分组微型营养评价法评分与血清营养学指标之间的相关性,并判断其隐性失血情况。结果与结论:(1)隐性失血:共101例患者发生高隐性失血,患者隐性失血量及其占总失血量的比例和高隐性失血发生率均随着营养状态的恶化而逐渐升高(P<0.05);(2)微型营养评价法评分:高隐性失血量患者置换前微型营养评价法评分,白蛋白、前白蛋白、转铁蛋白、淋巴细胞计数、淋巴细胞百分比和血红蛋白评估的隐性失血发生率明显高于低隐性失血量患者(P<0.01);(3)相关性分析:高隐性失血与置换前微型营养评价法评分、白蛋白、前白蛋白、转铁蛋白、淋巴细胞百分比和血红蛋白呈正相关(P<0.05);(4)结果证实:微型营养评价法营养风险评估可作为老年全髋关节置换患者入院营养状况筛查的可靠方法,其结合各种血清营养学指标可判断高隐性失血和预后情况。

BACKGROUND： Perioperative high hidden blood loss affects the recovery of joint function after total hip replacement. OBJECTIVE： To analyze the reliability of the Mini Nutritional Assessment on evaluating the nutritional status in elderly patients with femoral neck fracture on admission, and to investigate the effect of nutritional status variation on hidden blood loss after total hip replacement. METHODS： 234 elderly patients with femoral neck fracture underwent total hip replacement. By using Mini Nutritional Assessment, patients were randomly divided into three groups： well-nourishment group （n=52）, malnourishment at risk group （n=92）, and malnourishment group （n=90）. The results were used to analyze the correlation of Mini Nutritional Assessment and serological nutrition indicators, and to hidden blood loss. RESULTS AND CONCLUSION： （1） Hidden blood loss： 101 patients suffered from high hidden blood loss. Hidden blood loss, its proportion to total blood loss and incidence of high hidden blood loss gradually increased with the deterioration of the nutritional status （P 〈 0.05）. （2） Mini Nutritional Assessment： Pre-operative Mini Nutritional Assessment score, and the incidence of hidden blood loss evaluated by albumin prealbumin, transferrin, lymphocyte count, the percentage of lymphocytes and hemoglobin was significantly higher in patients with high hidden blood loss than those with low hidden blood loss （P 〈 0.01）. （3） Results of correlation analysis： High hidden blood loss was positively correlated with pre-operative Mini Nutritional Assessment, albumin, prealbumin, transferrin, the percentage of lymphocytes and hemoglobin （P 〈 0.05）. （4） These findings confirm that risk evaluation with Mini Nutritional Assessment is a reliable method to assess the nutritional status in elderly patients undergoing total hip replacement. Its combination with various serum nutrition indicators can determine high hidden blood loss and the prognosis.