腰椎融合术围手术期失血因素分析

Analysis of Perioperative Blood Loss Factors in Lumbar Fusion Surgery

腰椎融合术是骨科最常见的手术之一,是治疗腰椎退行性疾病的有效措施,可以矫正脊柱畸形,恢复脊柱的生理功能。然而围手术期失血是腰椎融合术最严重的并发症之一,也是导致伤口延迟愈合的主要原因。大量失血不仅会增加病死率,而且很难处理,给患者和社会带来了巨大的经济负担,预防是减少围手术期失血最重要的措施。失血因素有年龄、骨质疏松、融合节段数、手术方式与截骨、手术时间、术中终板损伤、麻醉方式与麻醉药物、术后加压与引流方式、高血压、糖尿病、血红蛋白和红细胞压积、Cobb角、美国麻醉师协会(ASA)分类、总血容量、手术水平的肌肉厚度、纤维蛋白原等。针对失血的预防理念必须贯穿整个围手术期,积极的预防措施能让失血降到最低。但目前国内研究腰椎融合术失血因素的文章较少。本文重点查阅国内外近3年腰椎融合术失血因素的文献并进行综合分析,总结各种因素对失血的影响。从不同角度阐述腰椎融合术可能的失血因素、止血措施,旨在明晰腰椎融合术失血因素,并且为国内外相关研究和临床治疗提供一定的思路和依据。

Lumbar fusion is one of the most common surgeries in orthopedics, which is an effective measure for treating degenerative diseases of the lumbar spine. It can correct spinal deformities and restore the physiological function of the spine. However, perioperative blood loss is one of the most serious complications of lumbar fusion surgery and the main cause of delayed wound healing. A large amount of blood loss not only increases the mortality rate, but is also difficult to manage, bringing a huge economic burden to patients and society. Prevention is the most important measure to reduce perioperative blood loss. Blood loss factors include age, osteoporosis, number of fusion segments, operation mode and osteotomy, operation time, intraoperative end plate injury, anesthesia mode and anesthetic drugs, postoperative compression and drainage mode, hypertension, diabetes, hemoglobin and hematocrit, Cobb angle, American Association of Anesthesiologists (ASA) classification, total blood volume, muscle thickness at operation level, fibrinogen, etc. The prevention concept for blood loss must run through the entire perioperative period, and proactive preventive measures can minimize blood loss. However, there are currently few articles in China studying the factors of blood loss in lumbar fusion surgery. This article focuses on reviewing literature on the factors causing blood loss in lumbar fusion surgery in the past three years both domestically and internationally, and conducting a comprehensive analysis to summarize the impact of various factors on blood loss. We elaborate on the possible bleeding factors and hemostatic measures of lumbar fusion surgery from different perspectives, intend to clarify the factors of blood loss in lumbar fusion surgery and provide certain ideas and basis for relevant research and clinical treatment at home and abroad.