股骨粗隆间骨折患者围手术期隐匿性失血的相关因素分析

Analysis on the related factors of perioperative occult blood loss in patients with femoral intertrochanteric fracture

目的:探讨股骨粗隆间骨折患者围手术期隐匿性失血的相关因素。方法:选取2017年1月~2020年1月27例股骨粗隆间骨折手术患者。入院资料包括年龄、性别、体质量指数(BMI)、美国麻醉医师协会(ASA)分级、血浆白蛋白、尿比重、骨折类型、手术类型、入院至手术时间。根据红细胞压积的变化,从计算的总失血量中减去观察到的围手术期失血量,计算出隐匿性失血量。比较防旋股骨近端髓内钉(PFNA)和股骨转子间顺行髓内钉(InterTAN)两种手术方式术中可见出血量、总出血量和隐匿性失血量的差异。结果:股骨粗隆间骨折患者的隐匿性失血在BMI亚组、血浆白蛋白亚组、尿比重亚组和手术类型亚组间差异均有统计学意义(P<0.05)。InterTAN组术中出血量、总失血量和隐匿性失血量均高于PFNA组(P<0.05)。多元线性回归分析显示,手术类型为InterTAN和入院时血浆白蛋白<30 g/L是股骨粗隆间骨折患者围手术期隐匿性失血量的关键影响因素(P<0.05)。结论:BMI>25 kg/cm^(2),尿比重>1.020、血浆白蛋白<30 g/L和InterTAN手术与更多的围手术期隐匿性失血量相关,且血浆白蛋白<30 g/L和InterTAN手术是股骨粗隆间骨折患者围手术期隐匿性失血量较大的危险因素。

Objective:To investigate the related factors of perioperative occult blood loss inpatients with femoral intertrochanteric fractures.Methods:Twenty-seven patients of femoral intertrochanteric fracturestreated surgically were included from January 2017 to January 2020.Admission information consisted of the age,gender,body mass index(BMI),physical status classification by American Society of Anesthesiologists(ASA),plasma albumin level,urine specific gravity,type of fractures,surgical modality,and time from admission to operation.The occult blood loss was calculated by the perioperative blood loss observed in operation minus the estimated total blood loss according to the changes in hematocrit.The differences of intraoperative blood loss observed,total blood loss and occult blood loss were compared and analyzed between the two surgical modalities of proximal femoral nail anti-rotation(PFNA)and antegrade intertrochanteric nail(InterTAN).Results:One-way analysis of the variance for occult blood loss during perioperative period showed that there was statistically significant difference among subgroups of BMI,plasma albumin level urine specific gravity and surgical modality(all P<0.05),and patients in the InterTAN group had larger intraoperative blood loss,total blood lossand occult blood loss than those in PEFNA group(P<0.05).Multivariate linear regression analysis showed that plasma albumin level<30g/L at admissionand modality of surgery by InterTAN were the key factors affecting perioperative occult blood loss(P<0.001).Conclusion:BMI>25 kg/cm^(2),urine specific gravity>1.020,plasma albumin level<30 g/L and surgery by InterTAN are associated with perioperative occult blood loss,particularly,plasma albumin level<30 g/L and InterTAN surgery are more risks of perioperative occult blood loss in patients with intertrochanteric fracture.