腰椎管狭窄术后隐性失血的研究  

HIDDEN BLOOD LOSS AFTER LUMBAR SPINAL STENOSIS OPERATION

作　　者：鞠洪斌[1] 郭东明[1] 蔡维山[1] 刘恩志[1] 钟波夫[1] 严翰[1] 

机构地区：[1]广州医学院附属广州市第一人民医院脊柱外科,广州510180

出　　处：《中国修复重建外科杂志》2009年第7期797-799,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨腰椎管狭窄手术相关的总失血量和隐性失血量,总结增加失血的危险因素。方法2002年9月-2006年7月,回顾性分析随访资料完整的138例腰椎管狭窄初次手术患者临床资料。男44例,女94例;年龄56～78岁,平均66.7岁。采用单纯后路腰椎管减压术26例,后路椎管减压、椎间撑开Cage加横突间植骨54例,椎弓根钉内固定加后路减压横突间植骨32例,后路椎管减压、椎弓根钉内固定加椎间Cage加横突间植骨26例。术前服用阿司匹林23例,术后发生胃肠道出血15例。术中失血量通过吸引器和手术台上情况进行统计;估计失血量根据入院和最终(术后第3天或第4天)的血色素水平、血容量及输血量进行计算。结果术中估计失血量为(1218.60±306.86)mL,明显多于术中失血量(485.51±143.75)mL,比较差异有统计学意义(P<0.001)。4种手术方法的术中失血量和估计失血量组间比较差异均有统计学意义(P<0.001);术前服用阿司匹林的患者术中失血量及估计失血量均大于未服用者(P<0.001);术后发生胃肠道出血的患者术中失血量及估计失血量均大于未发生者(P<0.001);以上统计估计失血量均明显高于术中失血量(P<0.001)。结论腰椎管狭窄手术总失血量明显大于术中观察到的失血量。手术方法的选择、术前使用阿司匹林、围手术期胃肠道出血为增加出血的因素。Objective To determine the total blood loss and hidden blood loss associated with surgery for lumbar spinal stenosis and to identify risk factors for blood loss. Methods From September 2002 to July 2006, the clinical data from 138 patients with lumbar spinal stenosis undergoing initial operation were analysed prospectively. There were 44 males and 94 females, aging 56-78 years （mean 66.7 years）. A simple posterior lumbar spinal decompression was used in 26 cases; posterior spinal canal decompression, interbody distraction Cage, and bone graft between transverse process was used in 54 cases; pedicle screw fixation, posterior decompression and bone graft between transverse process was used in 32 cases; posterior decompression, pedicle screw fixation, interbody Cage, and graft between transverse process was used in 26 cases . Before operation, 23 patients took aspirin, and after operation 15 patients had gastrointestinal bleeding. Intraoperative blood loss was calculated by the aspirator and observed blood loss intraoperation. The whole estimated blood loss was calculated according to the level of hemoglobin, blood volume and blood transfusion at the time of admission and after 3 and 4 days of operation. Results The blood loss intraoperation was （485.51 ± 143.75） mL. The estimated blood loss was （1218.60 _± 306.86） mL, which was significantly higher than the intraoperational blood loss （P 〈 0.001）. There was significant difference between the estimated blood loss and observed blood loss during surgeries （P 〈 0.001）. There were significant differences in the estimated blood loss and observed blood loss during surgery between patients treated with aspirin and without aspirin （P 〈 0.001 ）, between patients with gastrointestinal bleeding and whiout gastrointestinal bleeding （P 〈 0.001）. Conclusion The total blood loss after surgery for lumbar spinal stenosis is much greater than that of observed intra-operation. The type of surgery, treatment with aspirin and gastrointestinal bleedi

关 键 词：腰椎管狭窄 围手术期 隐性失血 

分 类 号：R687.3[医药卫生—骨科学]