PLIF手术隐性失血危险因素分析

Perioperative Factors Associated with Hidden Blood Loss in Patients Received PLIF

目的初步探讨经后路腰椎椎体间植骨融合术(posterior lumbar interbody fusion,PLIF)隐性失血与患者一般情况间的相关性。方法回顾性研究2016年10月至2017年10月在我院脊柱外科进行PLIF手术且临床资料完整的94例病例,其中男49例,女45例,年龄40~80岁,平均60.8岁。老年患者54例,超重42例。36例腰椎间盘突出症,46例腰椎椎管狭窄症,12例腰椎滑脱,其中单节段手术61例,双节段手术33例。统计患者年龄、性别、身体质量指数、手术时间、手术节段,统计术中失血量和术后引流量,评估隐性失血情况。分析患者的一般情况与围手术期隐性失血的相关性。结果手术时间(137.92±43.85)min,59例手术时间≥120min。围手术期总失血量(1 274.65±318.43)mL,显性失血量(746.44±118.62)mL,隐性失血量(529.47±189.53)mL,占总失血量的41.38%。单因素分析结果提示手术节段组内及手术时间组内隐性失血量差异均有统计学意义(P<0.01)。多元线性回归分析结果提示手术节段是隐性出血的独立危险因素之一。单节段手术组隐性、显性及总失血量均显著低于双节段组(P<0.01),但二者隐性失血量在总失血量中的比例差异无统计学意义(P>0.05)。结论 PLIF手术节段数量是隐性出血的独立危险因素之一。

Objective To analyze the correlation between the hidden blood loss and perioperative factors in patients received PLIF.Methods We retrospectively analyzed 94 patients underwent PLIF surgery.There were 49 males and 45 females,aged 40-80 years,with an average of 60.8 years old.There were 36 cases of lumbar disc herniation,46 cases of lumbar spinal stenosis,12 cases of lumbar spondylolisthesis,including 61 cases of single-segment surgery and 33 cases of double-segment surgery.And there were 54 elderly patients and 42 overweighted patients.The date were grouped according to perioperative factors such as gender,age,BMI,surgery level and operation time.And we evaluated the influence of perioperative factors on hidden blood loss.Results The operation time was（137.92±43.85）min,and the operation time of 59 cases was more than 120 min.The average perioperative total blood loss was（1 274.65±318.43）mL,with dominant blood loss of（746.44±118.62）mL,recessive blood loss of（529.47±189.53）mL.The recessive blood loss accounted for 41.38% of total blood loss.The single factor analysis showed the differences of hidden blood loss were statistically significant between different surgery level groups and different surgery time groups（P〈0.01）.Multivariate linear regression model showed surgery level was an independent risk factor influencing the hidden blood loss.The hidden blood loss in single level surgery group was significantly less than double levels surgery group（P〈0.01）.However,no obvious difference in ratio of hidden blood loss to total blood loss was observed（P〉0.05）.Conclusion Surgery levels is one of the independent factors affected hidden blood loss in patients received PLIF.More surgery time may associate with more hidden blood loss.