绿色通道髓内钉治疗老年股骨转子间骨折对围术期失血的影响

Analysis of perioperative blood loss by fast track protocol in cephalomedullary nailing for geriatric intertrochanteric fractures

目的研究开展绿色通道髓内钉内固定治疗老年股骨转子间骨折对围术期术前等待时间、手术时间、围术期失血等的影响,为临床治疗提供数据支撑。方法回顾分析2015年1月-2018年12月收治的符合选择标准的240例老年股骨转子间骨折患者临床资料,分为常规流程组(148例,A组)和绿色通道组(92例,B组),均采用闭合复位髓内钉(股骨近端防旋髓内钉)手术治疗。两组患者性别、年龄、侧别、骨折分型、骨折稳定性、合并症、合并3种以上内科疾病比例、受伤至入院时间等一般资料比较差异无统计学意义(P>0.05),具有可比性。记录并比较两组患者术前等待时间(入院至手术时间)、手术时间、48h手术完成率、72h手术完成率、输血率、不同时间点(入院时、手术当天及术后1、3d)红细胞比容(hematocrit,Hct)、骨折出血量、术中显性失血量、髓内钉隐性失血量、输血量、围术期总体失血量。结果B组患者术前等待时间、手术时间、手术当天和术后3dHct、骨折出血量、输血量及围术期总体失血量均显著少于A组,48h和72h手术完成率显著高于A组,差异有统计学意义(P<0.05);两组入院时和术后1dHct、术中显性失血量、输血率及髓内钉隐性失血量比较差异无统计学意义(P>0.05)。结论绿色通道的开展能有效降低老年股骨转子间骨折术前等待时间、骨折失血量和围术期总体失血量,减少输血量,早期手术利于改善患者围术期贫血状态。

Objective To analyze the effectiveness of fast track protocol of geriatric intertrochanteric fracture on operative waiting time, operation time, perioperative blood loss, providing data support for clinical therapy.Methods The clinical data of 240 elderly patients with intertrochanteric fracture admitted between January 2015 and December 2018 were retrospectively analyzed. They were divided into traditional protocol group(148 cases, group A) and fast track group(92 cases, group B). All patients were treated with closed reduction intramedullary nail(proximal femoral nail antirotation) surgery. There was no significant difference in gender, age, sides, fracture classification, fracture type,complications, the proportion of patients with more than 3 kinds of medical diseases, and the time from injury to admission between the two groups(P>0.05). Analysis index included operative waiting time(hospitalization to operation time), operation time, percentage of operation performing in 48 and 72 hours, percentage of transfusion, changes of hematocrit(Hct) at different stage(admission, operation day, and postoperative 1, 3 days), blood loss by fracture and cephalomedullary nail, intraoperative dominant blood loss, total blood loss in perioperative period were recorded and compared. Results The operative waiting time, operation time, Hct on operation day and postoperative 3 days, blood loss by fracture, transfusion volume, and total blood loss in perioperative period in group B were significantly less than those in group A(P<0.05), and the percentage of operation performing in 48 and 72 hours in group B were significantly higher than those in group A(P<0.05). There was no signifcant difference in Hct on admission and postoperative 1 day,intraoperative dominant blood loss, percentage of transfusion, blood loss by cephalomedullary nail between the two groups(P>0.05). Conclusion Fast track can shorten the operative waiting time of geriatric intertrochanteric fracture,reduce the blood loss by fracture, total blood loss in perioperative period, and transfusion volume. Early operation is conducive to improve the anemia status of patients during perioperative period.