154例老年股骨转子间骨折患者围手术期输血危险因素分析

Analysis of Risk Factors for Perioperative Blood Transfusion in 154 Elderly Patients with Intertrochanteric Fractures

目的分析股骨转子间骨折老年患者围手术期输血危险因素,为降低此类患者围手术期输血率、减少输血并发症相关伤害提供参考。方法选择2020年7月至2021年12月在我院接受治疗的154例老年股骨转子间骨折患者进行回顾性分析。收集患者临床资料,根据有无输血将患者分为2组,并比较2组患者的临床资料。在单因素分析基础上采用似然比前进法筛选变量,进行多因素非条件logistic回归分析,以判断各因素对患者输血的综合影响。结果本次调查的154例患者中共83例(53.90%)患者围手术期接受了输血治疗,平均输血量为(4.39±1.04)U。多因素分析结果显示,65岁及以上患者年龄增加、不稳定型骨折、全麻、手术耗时增加、术中出血量增加为股骨转子间骨折老年患者围手术期输血的危险因素,髓外固定、术前血红蛋白水平升高、术中自体血回输为保护因素。结论股骨转子间骨折老年患者围手术期输血率较高,主要受患者年龄、骨折类型、麻醉方式、内固定方式、手术耗时等因素的影响,临床上可通过对上述可干预的因素进行早期干预而降低患者输血率,减少输血并发症相关伤害。

Objective Analyze the risk factors for perioperative blood transfusion in elderly patients with femoral intertrochanteric fracture, and present guidelines for reducing the rate of perioperative blood transfusion and the damage associated with blood transfusion complications in these patients. Methods 154 elderly patients with intertrochanteric fractures who were treated in our hospital from July 2020 to December 2021 were selected for retrospective analysis. The clinical data of the patients were collected, and the patients were divided into 2 groups according to whether there had blood transfusion, and the clinical data of the patients in the 2 groups were compared.Variables were screened using the likelihood ratio advance approach based on univariate analysis, and multivariate unconditional logistic regression analysis was used to assess the overall impact of each factor on the patient’s blood transfusion. Result A total of 83(53.90%) of the 154patients in this investigation received blood transfusion during the perioperative period, with an average blood transfusion volume of 4.39±1.04U. The results of multivariate analysis based on univariate analysis showed that Increased age in patients over 65, unstable fractures, general anesthesia, increased operation time, and increased intraoperative blood loss are risk factors for perioperative blood transfusion in elderly patients with femoral intertrochanteric fractures. Extramedullary fixation,elevated hemoglobin level before operation, and intraoperative autologous blood transfusion were all found to be protective variables(P<0.05). Conclusions The perioperative blood transfusion rate in elderly patients with intertrochanteric fracture is relatively high, which is mainly affected by the patient ’ s age, fracture type, anesthesia method, internal fixation method,operation time-consuming and other factors, which can be clinically reduced by intervening the above factors Patient blood transfusion rate and reducing the harm related to blood transfusion complications in such patients.