腰椎后路手术后发生椎管内血肿的危险因素分析

Analysis of risk factors of spinal hematoma after lumbar posterior surgery

目的探讨腰椎疾病行腰椎后路手术术后椎管内血肿发生危险因素。方法回顾分析2007-05-2017-05收治的行腰椎后路手术者病例资料,选取术后椎管内血肿患者29例(血肿组),术后无并发症者68例(对照组)。统计各研究对象一般资料,腰椎疾病行腰椎后路手术术后椎管内血肿多因素Logistic回归分析。结果血肿组和对照组术前血清白蛋白、术前总蛋白、术前血小板、术前血钙水平、手术时间、术中出血量、术中异体输血以及术后总蛋白和术后血小板水平均存在统计学差异(P均<0.05)。经Logistic回归分析:术前总蛋白减少、术前血钙降低、术中出血量>1000ml、术后总蛋白减少是腰椎后路手术术后椎管内血肿的危险因素,P<0.05。结论腰椎疾病患者在行腰椎后路手术术前应注意监测术前总蛋白、术前血钙、术中出血量及术后总蛋白等情况,防止术后椎管内血肿发生。

Objective To investigate the risk factors of spinal hematoma after lumbar posterior surgery for lumbar diseases.Methods From May 2007 to May 2017,the clinical data of patients with posterior lumbar surgery in our hospital were retrospectively analyzed.Twenty-nine patients with postoperative hematoma were selected as hematoma group,and 68 patients without postoperative complications were selected as control group.The general information of the study subjects was collected,and multi factor logistic regression analysis was performed to analyze the risk factors of spinal hematoma after posterior lumbar surgery in lumbar diseases.Results The preoperative serum albumin,total protein,preoperative platelet,preoperative serum calcium level,operation time,intraoperative blood loss,blood transfusion,postoperative total protein and postoperative platelet levels between the hematoma group and control group had significant differences(P<0.05).Logistic regression analysis showed that preoperative total protein reduction,preoperative hypocalcemia,intraoperative blood loss>1000 ml and total protein reduction were the risk factors of spinal hematoma after lumbar surgery(P<0.05).Conclusion The preoperative total protein,preoperative blood calcium,intraoperative blood loss and postoperative total protein should be monitored before operation in patients with lumbar diseases to prevent the occurrence of postoperative intraspinal hematoma.