老年股骨粗隆间骨折患者围手术期失血的特征分析

Characteristics of Perioperative Hemorrhage in Elderly Patients with Intertrochanteric Fractures of Femur

目的分析老年股骨粗隆间骨折患者行髓内针内固定术围手术期失血的特征。方法选取2016年10—12月北京积水潭医院收治的153例65岁以上老年股骨粗隆间骨折行髓内针内固定术手术患者作为研究对象,根据围手术期是否存在大量失血分为两组,大量失血组67例,非大量失血组86例。比较两组患者的凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)和血小板计数(PLT)]、术前快速血栓弹力图指标[激活凝血时间(TEG-ACT)、血凝块形成时间(K)、凝固角(Angle)、最大振幅(MA)]、术后血红蛋白及围手术期输血情况。结果大量失血组患者的FIB水平较非大量失血组显著降低[(3.1±0.9)g/L比(3.4±1.1)g/L](P<0.05);两组患者的DD水平均升高,且大量失血组升高的比例显著高于非大量失血组[67.2%(45/67)比43.0%(37/86)](P<0.05)。大量失血组患者的术后血红蛋白水平低于非大量失血组[(10.1±1.3)g/L比(11.6±1.3)g/L](P<0.05)。结论老年股骨粗隆间骨折患者手术失血量增加以急诊入院时FIB水平降低、DD水平显著升高为主要特征。

Objective To analyze the characteristics of perioperative blood loss in elderly patients with intertrochanteric fracture of femur after internal fixation with intramedullary pin.Methods A total of 153 patients of intertrochanteric fracture of femur over 65 years old treated in Beijing Jishuitan Hospital from October to December 2016 were included in the study.According to occurrence of massive blood loss in perioperative period,67 cases were included as a massive hemorrhage group and 86 cases in a non-massive hemorrhage group.The coagulation indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-Dimer(DD)and platelet(PLT)],preoperative rapid thromboelastography indexes[activated clotting time(ACT),blood clot formation time(K),clotting angle(Angle),maximum amplitude(MA)],postoperative hemoglobin and perioperative blood transfusion were compared between the two groups.Results The FIB level in the massive hemorrhage group was significantly lower than that in the non-massive hemorrhage group[(3.1±0.9)g/L vs(3.4±1.1)g/L](P<0.05);the level of DD in both groups was increased,and the increased proportion in the massive hemorrhage group was significantly higher than that in the non-massive hemorrhage group[67.2%(45/67)vs 43.0%(37/86)](P<0.05).The postoperative hemoglobin level in the massive hemorrhage group was lower than that in the non-massive hemorrhage group[(10.1±1.3)g/L vs(11.6±1.3)g/L](P<0.05).Conclusion The increase of intraoperative bleeding volume in elderly patients with intertrochanteric fracture is mainly characterized by the decrease of FIB level and the significant increase of DD at the time of emergency admission.