围髋关节置换期隐性失血相关危险因素及预后  

Risk factors and prognosis of perioperative hidden blood loss in hip replacement patients

作　　者：李少斐[1,2] 郭亭[2] 赵建宁[1,2] 包倪荣[1,2] 

机构地区：[1]南京大学医学院临床学院,江苏省南京市210093 [2]解放军南京军区南京总医院骨科,江苏省南京市210002

出　　处：《中国组织工程研究》2014年第13期2006-2011,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省临床医学科技专项资助(BL2012002)~~

摘　　要：背景:隐性失血是骨科关节置换后常见话题,严重影响患者术后恢复及功能锻炼,多种因素与隐性失血有相关性,但具体机制尚未明确。目的:探讨患者髋关节置换前一般状况(性别、年龄、基础疾病、肥胖)、置换过程中假体类型、置换时间与隐性失血的相关性,及隐性失血量与患者预后的相关性。方法:纳入髋关节置换90例患者,置换前后监测患者红细胞比容、血红蛋白、凝血功能等多项血液学指标,统计患者身高、体质量、性别,根据Cross方程计算失血总量,后减掉显性失血,得到隐性失血的数值,根据文献报道,高于480 mL为高失血量组,低于480 mL为低失血量组,分析两组间性别、年龄、基础疾病、假体类型、置换时间等差异比较上述因素是否与隐性失血相关。并观测两组间围置换期并发症,术后1年短随访,观测两组间生存曲线。结果与结论:根据分组标准,共39例患者纳入高失血量组,其中有64.1%的男性,64.1%的高血压患者,35.9%的糖尿病患者,7.7%的骨水泥假体患者,51例低失血量组患者仅有37.3%的男性患者,25.5%的高血压患者,5.9%的糖尿病患者,35.3%的骨水泥假体患者,上述数据差异均有显著性意义。提示年龄、高血压、糖尿病、假体类型均为隐性失血的独立相关影响因素,肥胖和吸烟史与隐性失血无明显相关性。两组患者术后住院时间及1年内生存率存在统计学差异。BACKGROUND：Hidden blood loss, a frequent occurrence fol owing artificial joint replacement, greatly affects the recovery from total hip arthroplasty. Many factors have been shown to have a correlation with the hidden blood loss, but the specific mechanism is not yet clear. OBJECTIVE：To investigate the correlation of patients’ baseline （sex, age, underlying disease, obesity）, prosthesis types, surgical time with hidden blood loss fol owing total hip arthroplasty, as wel as the association between hidden blood loss and prognosis. METHODS：Ninety patients undergoing total hip arthroplasty were enrol ed in this study. Using Gross formula, we calculated the total blood loss according to height, weight, and pre-and post-operative hematocrit, and subtracted the dominant loss of blood to get the quantitative value of hidden blood loss. According to the criterion, the 90 patients were divided to two groups：group I：volume of hidden blood loss〉480 mL, group II：volume of hidden blood loss RESULTS AND CONCLUSION：There were 39 patients in the group I, including 64.1%males, 64.1%hypertension patients, 35.9%diabetic patients, 7.7%patients receiving cement prosthesis;while, there were 51 patients in the group II, including 37.3%males, 25.5%hypertension patients, 5.9%diabetic patients, 35.3%patients receiving cemented prosthesis, showing a significant difference between the two groups. Based on these experimental findings, age, hypertension, diabetes mel itus, type of prosthesis were shown to be factors independently associated with hidden blood loss;however, obesity and smoking exhibited no correlation with hidden blood loss. In addition, a statistical difference in the survival rate was found at admission and during the 1-year fol ow-up.

关 键 词：植入物 人工假体 全髋关节置换 隐性失血 基础疾病 肥胖 随访 预后 

分 类 号：R318[医药卫生—生物医学工程]