腰椎多节段内固定术中失血量准确评估的研究

A retrospective study on accurate blood loss in multi-segmental lumbar fusion surgery

背景:腰椎手术常伴随大量失血,且失血形式不仅局限于术中可见的显性出血,围手术期的隐性失血同样意义重大。目的:通过对腰椎多节段内固定术术前、术后即刻血常规的监测,以及手术过程中显性出血的准确计算,研究腰椎多节段内固定手术过程中隐性失血的情况,从而更科学地了解患者失血量变化,及时纠正贫血。方法:回顾性分析2014年11月至2016年1月因腰椎退行性疾病而行手术治疗的患者。统计患者身高、体重、手术节段及手术当天早晨及术后1 h内血常规检查结果以获取患者血细胞比容信息,并准确测量手术前后纱布重量、术中液体冲洗量及吸引器内液体量。根据以上数据,通过Gross方程计算患者术中显性失血量、理论总失血量和隐性失血量。结果:共纳入78例患者,男34例,女44例,平均年龄(55.3±15.2)岁。手术时间(134.2±30.0)min,麻醉时间(162.0±32.5)min。患者理论总失血量为(726.5±276.3)ml,其中显性失血量(396.6±155.3)ml,隐性失血量(329.8±234.6)ml,隐性失血量占总失血量42.3%。结论:腰椎多节段内固定手术过程中存在大量隐性失血,因此在护理工作中不能单纯靠显性失血评估患者贫血及循环情况。重视隐性失血、准确评估患者失血量有助于提高临床护理水平,帮助患者平稳度过围手术期。

Background：Lumbar spine surgery is often accompanied by massive blood loss which composes of not only intraoperative visible bleeding but also perioperative recessive blood loss.Objective：To explore accurate blood loss in multisegmental lumbar fusion surgery.Methods：We performed a retrospective research and recruited patients who were scheduled to receive lumbar fusion surgeries from November 2014 to January 2016.Clinical data including age,height,weight,body mass index（BMI）,surgical levels,intra-operative blood loss and results of routine blood test were collected.According to above data and Gross formula,we calculated the total blood volume and hidden blood loss.Results：In this study,78 patients who met the inclusion criteria were enrolled.There were 34 males and 44 female with an average age of（55.3 ±15.2） years old.The operative duration was（134.2±30.0） min and anesthesia duration was（162.0±32.5） min.Patient＇s total blood volume was（726.5±276.3） ml,including（396.6±155.3） ml operative blood loss and（329.8±234.6） ml hidden blood loss.The hidden blood loss accounted for 42.3% of the total blood loss.Conclusions：Multi-segmental lumbar fusion surgery is associated with substantial perioperative hidden blood loss,which should not be ignored in our daily work.The accurate assessment for blood loss in lumbar fusion surgery is important for peri-operative nursing.