股骨干骨折髓内固定患者围手术期失血量评估及相关因素分析  

Perioperative blood loss in femoral fracture patient with underlying disease:a potential risk assessment

作　　者：汤文杰[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中国矫形外科杂志》2016年第6期500-503,共4页Orthopedic Journal of China

摘　　要：[目的]对股骨干骨折髓内固定患者围手术期失血量进行评估并对影响因素进行分析比较。[方法]回顾性分析2012年3月～2014年3月于本院创伤骨科收治的81例股骨干骨折患者（男37例,女44例）病例资料,收集患者入院时、术前1 d和术后1 d血红蛋白和红细胞压积、术中出血量、自异体输血量等资料。根据Gross方程和Nadler方程计算围手术期总失血量、隐性失血量;计算围手术期隐性或显性失血量占比和术前/术后隐性失血量占比;比较分析年龄、性别、手术时间、受伤与手术的时间间隔、是否合并糖尿病、高血压等因素对失血量的影响。[结果]股骨干骨折髓内固定显性失血量（216.9±118.3）ml显著低于隐性失血量（451.4±225.9）ml（P〈0.05）;术前隐性失血量（134.3±73.7）ml显著低于术后隐性失血量（317.1±215.7）ml,且差异具有统计学意义（P〈0.05）。糖尿病患者组显性失血量和总失血量（570.2±216.9）ml和（781.9±218.9）ml,明显高于非糖尿病组患者显性失血量（361.1±189.4）ml和总失血量（581.9±248.1）ml（P〈0.05）;高血压组患者显性失血量（275.9±203.8）ml、隐性失血量（519.19±239.2）ml和总失血量（795.0±231.4）ml均分别明显高于非高血压组患者显性失血量（174.3±220.6）ml、隐性失血量（402.59±204.6）ml和总失血量（576.7±232.6）ml,差异具有统计学意义（P〈0.05）。[结论]股骨干骨折髓内固定围手术期隐性失血现象不容忽视;对于高能量损伤患者应密切关注围手术期血红蛋白水平变化;基础疾病可能会增加其围手术期失血量。[ Objective] To investigate the risk factors of the perioperative blood loss for the patient with femoral shaft fraeute. [ Method] Eighty- one patients （male 37 cases, female 44 cases ） with femoral shaft fracute between March 2012 and March 2014 were enrolled in the study. The hemoglobin, hematocrit and autotransfusion/allotransfusion at admission, pre -oper- ation and at one day after operation, and intraoperative blood loss were recorded, respectively. According to the Gross equation, we calculated the total perioperative and hidden blood loss. And the percentage of perioperative hidden blood loss and dominant blood loss were calculated as well. Then, we analyzed the influence factors on the blood loss of the femoral shaft fracture, inclu- ding gender, age, the days between trauma and operation, operation time, the medical disease such as hypertension and diabetes. [ Result ] The dominant blood loss of the intramedullary fixation for the patient with femoral shaft fracute （216.9 ± 118.3 ） ml was lower than the hidden blood loss （451.4± 225.9 ） ml, with significant difference （P 〈 0.05 ）. The perioperative hidden blood loss （ 134.3 ± 73.7 ） ml was significantly lower than the postoperative hidden blood loss （ 317.1 ±215.7 ） ml （ P 〈 0.05 ）. Meanwhile,the dominant blood loss（570.2 ±216.9）ml and total blood loss（781.9 ± 218.9） ml in the diabetes group were higher than those in the non - diabetes group [ （ 361.1 ± 189.4） ml and（ 581.9± 248.1 ） ml] （ P 〈 0.05 ）. In the hypertension group, the dominant blood loss （ 275.9 ± 203.8 ） ml, hidden blood loss （ 519.19 ± 239.2 ） ml and total blood loss （ 795.0± 231. 4） ml were significantly higher than those [ （ 174.3 ± 220.6 ） ml, （ 402.59± 204.6 ） ml and （ 576.7 ± 232.6） ml, respectively ] in the non- hypertension group（ P 〈 0.05 ）. [ Conclusion] The perioperative hidden blood loss of femoral shaft fracture should not be ignored. More attention should be paid to the periopera

关 键 词：股骨干骨折 髓内固定 隐性失血 影响因素 

分 类 号：R687.3[医药卫生—骨科学]