老年股骨粗隆间骨折患者围手术期失血分析及输血时机探讨

The analysis of perioperative period blood loss and the timing of blood transfusion in the aged patients with femoral intertrochanteric fracture

目的评价老年股骨粗隆间骨折患者手术治疗前后红细胞比容(HCT)、血红蛋白(HGB)、隐性失血量等的变化。方法回顾分析北京老年医院2013年1月—2015年12月收治的老年股骨粗隆间骨折患者的病例资料,利用EpiData建立数据库,根据Gross方程来计算隐性失血量,手术前后HCT、HGB指标的变化情况采用t检验。结果依据纳入标准,33例病例进入数据库。手术平均出血量为91.52 ml。33例病例术前HCT均值为33.34±4.79,术后第3天最低(26.53±4.49),此后有回升趋势。33例病例隐性失血量术后第3天最多(790.25 ml),占总失血量比例也最高(92.10%),此后开始减少。输血组和未输血组的HCT术前与术后第1、3、5、7天比较,差异均具有统计学意义(P<0.05)。输血组HCT术前和术后第3、5、7天与未输血组比较,差异无统计学意义;输血组HCT术后第1天和未输血组比较,差异具有统计学意义(P<0.05)。输血组HGB术前与术后第1、3天比较,差异均具有统计学意义(P<0.05);术前与术后第5、7天比较,差异无统计学意义。未输血组HGB术前与术后第1、3、5、7天比较,差异均具有统计学意义(P<0.05)。输血组HGB术前、术后第1天与未输血组比较,差异具有统计学意义(P<0.05),输血组HGB术后第3、5、7天与未输血组比较,差异无统计学意义。结论老年股骨粗隆间骨折患者隐形失血量大于手术记录出血量,在临床工作中应当密切监测患者HGB、HCT变化值,尤其术后3~5d最为重要,估算出隐性失血量及围手术期失血量并给予相应治疗。

Objective To evaluate the changes of HCT, HGB and hidden blood loss in the patients with femoral intertrochanteric fracture before and after the treatment. Methods We conducted a retrospective analysis of the cases data of the aged patients with femoral intertrochanterie fracture from January,2013 to December,2015 ,built a database with EpiData and calculated the hidden blood loss with Gross equation. The changes of HCT and HGB were analyzed with t test. Results According to inclusion criteria,33 cases entered the database,with 91.52 ml average blood loss during operation. The average HCT mean of 33 cases was 33.34±4.79 before surgery,followed by the lowest （26.53±4.49） on the third day after surgery and then it tended to increase. On the third day after surgery ,The hidden loss blood in 33 cases was the highest（790.25 ml,92.10% ）. There were statistical differences between HCT before operation and those on the first day, third day, fifth day, seventh day after operation in transfusion group （P 〈 0.05 ）. There were statistical differences between HCT before operation and those on the first day, third day, fifth day, seventh day after operation in no-transfusion group（P 〈 0.05 ）. There were no statistical differences between HCT before operation,on the third day,fifth day, seventh day after operation in transfusion group and those in no-transfusion group. There was statistical difference between HCT on the first day after operation in transfusion group and that in the non-transfusion group （ P 〈 0.05 ）. There were statistical differences between HGB before operation and those on the first day, on the third day in transfusion group （ P 〈 0.05 ）. There was no statistical difference between HGB before operation and those on the fifth, on the seventh day after opera- tion. The differences were statistically significant （ P 〈 0.05 ） between HGB before operation and those on the first day, third day, fifth day, seventh day after operation in no-transfusion group （ P 〈 0.05 ）. There were statistical differences be- tween HGB in the transfusion group before operation and on the first day after operation and those in no-transfusion group （ P 〈 0.05 ）. The differences were not significant between HGB in transfusion group on the third, fifth, seventh day after operation and those in the no-transfusion group. Conclusion The record of hidden blood loss of elderly patients with femoral intertrochanteric fracture should be closely monitored in the clinical work together with HGB, HCT value changes, especially on the third and fifth day ＇after operation. We should estimate the hidden blood loss and perioperative blood loss and then give them corresponding treatments.