血清营养学指标与全髋关节置换术失血的相关研究

The correlational study between hidden blood loss and serological examinations

目的探讨血清营养学指标与全髋关节置换隐性失血之间的相关性。方法根据患者术中失血量、术后出血量、手术前后红细胞压积和输血量,计算患者的总失血量、隐性失血量、原血量和总失血量的比例,按照平均隐性失血量占总失血量的比,分低隐失血组和高隐失血组,分析高隐失血与术前血清营养学指标总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRA)、淋巴细胞计数(TLC)、淋巴细胞百分比(TLP)、血红蛋白(HB)之间的关系。结果所有患者失血量平均为1298.47 m L,占原血量的30.13%;隐性失血总量平均517.03 m L,占总失血量的39.82%;101例患者发生高隐性失血,高隐性失血量组术前ALB、PA、TRA和TLP的平均数值明显低于低隐失血量组(P<0.05),高隐性失血量组术前ALB、PA、TRA、TLC、TLP和HB评估的隐性失血发生率明显高于低隐失血量组(P<0.05),高隐失血与ALB、PA、TRA、TLP和HB相关性强(相关系数分别为0.587、0.517、0.687、0.395和0.387,均P<0.05)。结论血清营养学指标(ALB、PA、TRA、TLP和HB)与关节置换术后高隐性失血紧密相关,判断高隐性失血的重要指标。

Objective To identify the correlation between hidden blood loss and serological examinations. Methods The total blood loss, hidden blood loss and their proportion on the original blood volume and total blood loss was calculated depending on height, weight, intra-operative blood loss, post-operative blood loss, pre -and post-operative Hct, and blood transfused. According to the proportion of mean hidden blood loss on total blood loss, patients were divided into low hidden blood loss group and high hidden blood loss group. Then, we analyzed the relationship among high hidden blood loss and preoperative serological examinations （ TP, ALB, PA, TRA, TLC, TLP and Hb）. Results The mean total blood loss was 1298.47 mL, accounting for 30.13% of the original blood volume. The mean hidden blood loss was 517.03 mL, accounting for 39.82% of the total blood loss. 101 of 234 cases were found to have high hidden blood loss, and the preoperative data of ALB, PA, TRA and TLP in high hidden blood loss group was higher than that in low hidden blood loss group （P〈0.05）. The preoperative incidence of hidden blood loss assessed by ALB, PA, TRA, TLC, TLP and Hb in high hidden blood loss group was markedly higher than that in low hidden blood loss group （ P〈0.05） . The preoperative ALB, PA, TRA, TLP and Hb showed strong correlation with high hidden blood loss （ correlation coefficients was 0. 587, 0. 517, 0. 687,0.395 and 0. 387, respectively, P〈0.05） . Conclusion The serological examinations （ ALB, PA, TRA, TLP and Hb） had significant value in predicting the risk of high hidden blood loss and could be considered as important indicators for judging high hidden blood loss.