颈椎后路单开门椎管扩大成形术后隐性失血的影响因素分析

Risk Factorsin Hidden Blood Loss in Cervical Spine Posterior Open-door Laminoplasty

目的评估颈椎后路单开门椎管扩大成形术后隐性失血量,确定影响隐性失血相关的危险因素。方法回顾性分析2018年2月至2020年7月接受颈椎后路单开门椎管扩大成形术的55例患者的临床资料,51例符合所有纳入标准。其中男30例,女21例;年龄37~79岁,平均(59.90±9.75)岁。记录术前和术后的红细胞压积,根据Sehat公式计算隐性失血量,并对危险因素进行多元线性回归分析,包括年龄、性别、身高、体重、身体质量指数、血浆白蛋白、血糖、美国麻醉师学会评分、手术时间。结果本组隐性失血量平均为(230.29±169.70)mL,占总失血量的(35.1±25.1)%。多元回归分析显示,性别和手术时间对隐性失血量有显著影响,是其独立危险因素。男性患者的隐性失血量为(283.11±194.68)mL,明显高于女性患者的(154.82±82.91)mL,P=0.034。手术时间与隐性失血量呈正相关。结论隐性失血量在颈椎后路单开门椎管扩大成形术后患者总失血量中占很大比例。男性患者和更长的手术时间是隐性失血的独立危险因素。年龄、身高、体重、BMI、血浆白蛋白、血糖、美国麻醉师学会评分与隐性失血无关。

Objective To evaluate the amount of hidden blood loss after the cervical spine posterior open-door laminoplasty and to identify the associated factors that may contribute to HBL.Methods The clinical data of 55 patients who underwent the cervical spine posterior open-door laminoplasty from February 2018 to July 2020 were analyzed retrospectively.Finally,51 patients met all the inclusion criteria.Hematocrit was recorded before and after the operation,whereafter,the HBL was calculated according to Sehat formula.Meanwhile,multivariate linear regression analysis was used to further analyze the risk factors,including age,sex,height,weight,body mass index,plasma albumin,glucose,American Society of Anesthesiologists score and operation time.Results 30 males and 21 females,average aged(59.90±9.75)years.The HBL was(230.29±169.70)mL,with a percentage of(35.1±25.1)%in the totalblood loss after surgery.Multivariate linear regression analysis showed that sex and operation time had significant influence on HBL,which were independent risk factors.The HBL of male patients was(283.11±194.68)mL,which was significantly higher than that of female patients,mean(154.82±82.91)mL,P=0.034.The time of operation was positively correlated with the amount of occult blood loss.Conclusion The HBL accounts for a large proportion of the total blood loss after the cervical spine posterior open-door laminoplasty.Male patients and longer duration of surgery were independent risk factors for HBL.Age,height,weight,BMI,ALB,GLU,ASA score were not associated with hidden blood loss.