股骨转子间骨折围手术期隐性失血的性别差异研究

Study of gender difference on perioperative hidden blood loss of intertrochanteric fracture

目的研究性别差异对股骨转子间骨折围手术期隐性失血的影响。方法回顾性分析2012年1月至2015年12月收治的108例股骨转子间骨折患者资料，男42例，女66例；年龄32～05岁，平均（75．4±10．8）岁。运用Gross方程，计算所有患者围手术期隐性失（perioperative hidden blood loss, PHBL）的绝对值及其所占总血容量的百分比为因变量，均以性别、年龄、受伤至手术时间、受伤侧别、骨折Evans分型、美国麻醉医师协会（American Society of Anesthesiologists, ASA ）分级及麻醉方式为自变量，建立两个多元直线回归方程，研究因变量与自变量之间的关系；比较男性和女性围手术期血红蛋白水平、红细胞压积、总血容量、PHBL的绝对值及百分比的差异。结果年龄、受伤至手术时间、受伤侧别、骨折Evans分型、患者ASA分级及麻醉方式与围手术期隐性失血的绝对值和百分比均无线性回归关系；性别与隐性失血的绝对值无线性关系，但与隐性失血的百分比呈线性回归关系。男性患者术前血红蛋白水平平均（121．8±16．6）g/L，女性平均（99．5±13．1）g/L；红细胞压积均值男性为36．7％±5．0％，女性为30．6％±3．7％。男性患者术后血红蛋白水平平均（103．4±19．3）g/L，女性平均（79．0±10．4）g/L；红细胞压积均值男性为29．8％±4．2％，女性为23．9％±2．6％。男、女性无论是在入院还是在术后，血红蛋白和红细胞压积比较差异均有统计学意义。男性患者的总血容量平均为（4500．6±191．5）ml，女性为（3607．0±235．7）ml；两者总血容量比较，差异有统计学意义。男性患者PHBL绝对值平均为（647．9±174．1）ml，女性为（694．8±216．5）ml；百分比均值男性为14．4％±4．0％，女性为19．3％±6．1％；男、女性PHBL绝对值比较差异无统计学意义，但两者百分比比较差异有统计学意义。结论女性患者的围手术期隐性失血量占总血容量的百分比大于男性，因此临床上需更加重视女性患者的隐性失血情况，必要时及时纠正。

Objective To investigate the hidden blood loss of intertrochanteric fractures in different gender. Methods Data of 108 patients with intertrochanteric fractures who were admitted to the department of orthopaedics from January 2012 to De- cember 2015 were retrospectively analyzed. For all patients who were composed of 42 males and 66 females and whose ages ranged from 32 to 95 years old, the average age was 75.4±10.8 years old. With the equation of Gross, the amount of perioperative hidden blood loss （PHBL） was calculated as well as the fraction of PHBL. The lineal regression model was utilized to analyze the correlations between PHBL and those factors including age, time interval between injury and surgery, injured side, Evans classifi- cation of intertrochanteric fractures, patients＇ ASA grade, and type of anesthesia. The difference of hemoglobin （Hb）, hematocrit （Hct）, total blood volume, the amount of PHBL, and the percentage of PHBL were respectively compared between male group and female group. Results PHBL had no correlation of lineal regression with age, time interval between injury and surgery, injured side, Evans classification of intertrochanteric fractures, patients＇ ASA grade, or the type of anesthesia. The share of PHBL did not have correlation of lineal regression with age, time interval between injury and surgery, injured side, Evans classification of inter- trochanteric fractures, patients＇ ASA grade, or the type of anesthesia as well. Lineal regressive correlation only existed between gender factor and the PHBL fraction of total blood volume, and there was no regressive correlation between gender factor and the amount of PHBL. In the male group, the mean amount of preoperative Hb was 121.8±16.6 g/L and preoperative Hct was averagely 36.7%-5.0%; in the female group, the amount of preoperative Hb was 99.5±13.1 g/L on average and the mean amount of Hct was preoperatively 30.6%± 3.7%. Postoperatively, the mean amount of preoperative Hb was 103.4± 19.3 g/L and Hct was averagely 29.8%±4.2%; in the female group, the amount of postoperative Hb was 79.0±10.4 g/L on average and the mean amount of Hct was postoperatively 23.9%±2.6%. Significant difference of perioperative Hb and Hct was found between two groups. The total blood volume was averagely 4 500.6±191.5 ml in the male group and 3 607.0±235.7 ml in the females group. There was statistical differ- ence between two groups. For male group, the amount of PHBL was 647.9±174.1 ml on average and accounted for 14.4%±4.0% of total blood volume. For the female group, the mean amount of PHBL was 694.8±216.5 ml and making up 19.3%±6.1% of the total blood volume. As for the amount of PHBL, no significant difference was observed between male group and female group, but there was statistical difference of the share of PHBL accounting for total blood volume between two groups. Conclusion Female patients＇ PHBL fraction of total blood volume is greater than male patients＇, therefore females＇ PHBL conditions need to be paid more attention to and ought to be corrected in time.