高海拔地区股骨干骨折行切复内固定治疗患者围手术期失血量评估及影响因素分析

Analysis of influencing factors and evaluation of perioperative blood loss in patients with femoral shaft fracture treated with open reduction and internal fixation at high altitude areas

目的评估高海拔地区股骨干骨折切复内固定治疗患者围手术期失血量,并分析其影响因素。方法回顾性分析西藏自治区阿里地区人民医院收治的62例股骨干骨折行切复内固定治疗患者的临床资料,观察患者的总失血量、隐性失血量及显性失血量,并分析影响患者围手术期失血量的因素。结果患者术后5 d的HGB、HCT、RBC水平均低于术前及术后1、3、7 d。患者总失血量为(1 452.5±180.9)mL,隐性失血量为(1 036.8±142.3)mL,显性失血量为(453.6±97.6)mL。隐性失血比例明显高于显性失血比例,差异具有统计学意义(P<0.05)。年龄≥50岁患者的隐性失血量、总失血量明显多于<50岁患者(P<0.05);BMI≥25 kg/m2患者的显性失血量、隐性失血量、总失血量均明显多于BMI<25 kg/m2患者,差异具有统计学意义(P<0.05);股骨干下1/3处骨折患者隐性失血量、总失血量明显多于股骨干上1/3处及中段骨折患者,差异具有统计学意义(P<0.05);手术时间≥2.0 h患者的显性失血量、总失血量均明显多于手术时间<2.0 h患者,差异具有统计学意义(P<0.05);有高血压、糖尿病患者的显性失血量、隐性失血量、总失血量均明显多于无高血压、糖尿病患者,差异具有统计学意义(P<0.05)。结论隐性失血是高海拔地区股骨干骨折患者围手术期的主要失血方式,年龄、BMI、骨折部位、手术时间、糖尿病、高血压是隐性失血量的影响因素。

Objective To evaluate the perioperative blood loss and analyze the influencing factors in patients with femoral shaft fracture treated with open reduction and internal fixation at high altitude areas. Methods The clinical data of 62 cases of femoral shaft fracture treated with open reduction and internal fixation in the People's Hospital of Ali Prefecture were retrospectively analyzed. The total blood loss, hidden blood loss and obvious blood loss were observed, and the factors influencing the perioperative blood loss were analyzed. Results The levels of HGB, HCT and RBC at 5 days after operation were lower than those before operation and at 1, 3 and 7 days after operation. The total blood loss was (1 452.5依180.9) mL, the hidden blood loss was (1 036.8依142.3) mL, and the obvious blood loss was (453.6依97.6) mL. The proportion of hidden blood loss was significantly higher than that of obvious blood loss (P<0.05). The total blood loss and hidden blood loss of patients with age 逸50 years were significantly more than those of patients with age 约50 years (P<0.05). The obvious blood loss, hidden blood loss and total blood loss in patients with BMI逸25 kg/m2 were significantly more than those in patients with BMI<25 kg/m2 (P<0.05). The hidden blood loss and total blood loss of patients with lower 1/3 femoral shaft fractures were significantly more than those of patients with upper 1/3 and middle femoral shaft fractures, and the differences were statistically significantly (P<0.05). The obvious blood loss and total blood loss in patients of operation time逸2.0 h were significantly more than those in patients of operation time <2.0 h, and the differences were statistically significantly (P<0.05). The obvious blood loss, hidden blood loss and total blood loss in patients with hypertension and diabetes mellitus were significantly more than those in patients without hypertension and diabetes mellitus, and the differences were statistically significantly (P<0.05). Conclusion Hidden blood loss is the main mode of perioperative blood loss in patients with femoral shaft fracture at high altitude areas, and the age, BMI, fracture site, operation time, diabetes mellitus and hypertension are the influencing factors for hidden blood loss.