术前纤维蛋白原、血红蛋白及凝血酶原时间与髋关节置换术后输血的关系

Relationship between preoperative fibrinogen,hemoglobin,and prothrombin time and postoperative blood transfusion in hip replacement surgery

目的 分析术前纤维蛋白原、血红蛋白及凝血酶原时间与髋关节置换术后输血的关系。方法 选取四川大学华西医院2015年1月至2018年12月收治的284例髋关节置换术患者为研究对象,收集所有患者术前一般临床资料、术前血常规及凝血功能等实验室指标检测结果,根据术后是否输血分为输血组72例,未输血组212例,比较输血组与未输血组一般临床资料及相关实验室指标,将具有统计学意义的指标进一步纳入多因素二元回归Logistic回归方程,分析影响髋关节置换术后输血的危险因素。绘制受试者工作特征(ROC)曲线,分析术前纤维蛋白原、血红蛋白及凝血酶原时间单一与联合对术后输血的预测价值。结果 输血组与非输血组年龄、BMI、高血压、骨质疏松、手术时长、纤维蛋白原、血红蛋白、凝血酶原时间比较差异具有统计学意义(P<0.05)。经二元回归Logistic回归方程分析得:手术时长增加、纤维蛋白原浓度降低、血红蛋白浓度降低及凝血酶原时间延长是影响髋关节置换术后输血的危险因素(P<0.05)。纤维蛋白原、血红蛋白及凝血酶原时间联合预测灵敏度、特异度分别为90.27%、84.34%,AUC为0.755(P<0.05)。结论 手术时长增加、纤维蛋白原浓度降低、血红蛋白浓度降低及凝血酶原时间延长是影响髋关节置换手术术后输血的独立危险因素,对于术后输血的早期预判发生具有重要的预测价值。

Objective To analyze the relationship between preoperative fibrinogen,hemoglobin,and prothrombin time and postoperative blood transfusion in hip replacement surgery.Methods A total of 284 patients who underwent hip replacement durgery at West China Hospital of Sichuan University from Janu-ary 2015 to December 2018 were selected as the research subjects.Ther preoperative general clinical data,pre-operative blood routine,coagulation function and other laboratory test results were collected for all patients.Based on whether they received blod transfusion after surgery,the patients were divided into two groups:the blood transfusion group(72 cases)and the non-blood transfusion group(212 cases).The general clinical data and relevant laboratory indicators of two groups were compared,and statistically significant indicators were in-cluded in a multi-factor binary regression logistic regression equation to analyze the risk factors affecting blood transfusion after hip replacement.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of preoperative fibrinogen,hemoglobin and prothrombin time individual and in combination for postoperative blood transfusion.Results Statistically significant differences were found in age,BMI,hy-pertension,osteoporosis,surgical duration,fibrinogen,hemoglobin,and prothrombin time between the trans-fusion group and non transfusion group(P<0.05).Through logistic regression equation analysis,it was deter-mined that an increase in preoperative surgical duration,a decrease in fibrinogen concentration,a desrease in hemoglobin concentration and a prolonged prothrombin time were risk factors for blood transfusion after hip re-placement(P<0.05).The combined predictive sensitivity and specificity of fibrinogen,hemoglobin and pro-thrombin time were 90.27%and 84.34%,respectively.The AUC was 0.755(P<0.05).Conclusion An in-crease in preoperative surgical duration,a decrease in fibrinogen concentration,a decrease in hemoglobin con-centration and a prolonged prothrombin time are all independent risk factors for postoperative blood transfusion after total hip replacement surgery.These factors have significant predictive value for early detection of the need for postoperative blood transfusion.