全髋关节置换术后低蛋白血症的危险因素分析

Risk factors of hypoproteinemia after total hip arthroplasty

背景:全髋关节置换术(THA)后低蛋白血症一直是围手术期管理的难点,影响患者的术后康复,但其影响因素尚不明确。目的:分析新型营养管理模式下初次单侧THA术后低蛋白血症的独立危险因素。方法:回顾性分析2017年3月至2019年5月行初次单侧THA的237例患者。术后血清白蛋白水平<30 g/L的患者定义为低蛋白血症,共计83例(低蛋白血症组),其余154例患者作为正常组。应用Logistic回归分析初次单侧THA术后低蛋白血症的独立危险因素。结果:初次单侧THA术后低蛋白血症的独立危险因素包括围手术期失血量(OR=1.002,P<0.001)及手术当天输液量(OR=1.001,P=0.026);术前白蛋白水平是术后低蛋白血症的保护性因素(OR=0.818,P<0.001)。低蛋白血症组患者伤口并发症发生率高于正常组患者[25.3%(21/83)vs 5.8%(9/154)],且差异有统计学意义(χ^(2)=18.468,P<0.001)。结论:围手术期失血量和手术当天补液量增多会增加初次单侧THA术后低蛋白血症的风险。术前白蛋白水平更高的患者,术后出现低蛋白血症的风险水平更低。

Background:Hypoproteinemia after total hip arthroplasty(THA)is always the difficulty of perioperative management,which affects the postoperative rehabilitation and its risk factors are still not clear.Objective:To analyze the risk factors of hypoproteinemia following new multimodal nutritional management after primary unilateral THA.Methods:A retrospective analysis was conducted in 237 patients who underwent primary unilateral THA from March 2017 to May 2019.The patients whose postoperative serum albumin level was less than 30 g/L was defined as hypoproteinemia group(83 cases),and the rest(154 cases)as normal control group.Multivariate logistic regression model was used to identify independent risk factors for hypoproteinemia following primary THA.Results:The independent risk factors for hypoproteinemia were perioperative blood loss(OR=1.002,P<0.001)and infusion volume on the day of surgery(OR=1.001,P=0.026).High preoperative serum albumin level was a protective factor for postoperative hypoproteinemia(OR=0.818,P<0.001).The rate of wound complications in hypoproteinemia group was significantly higher than that in normal control group(25.3%vs 5.8%,χ^(2)=18.468,P<0.001).Conclusions:More total blood loss and infusion volume on the day of surgery will increase the risk of hypoproteinemia.However,high preoperative level of serum albumin will contribute to reduce the risk of hypoproteinemia following primary THA.