不同营养状态老年股骨转子间骨折PFNA内固定治疗患者围术期隐性失血情况分析  

Analysis of perioperative hidden blood loss in intertrochanteric fracture patients with different nutritional status treated by PFNA internal fixation

作　　者：陈聪[1] 范永前[1] 梁承伟[1] 

机构地区：[1]复旦大学附属华东医院骨科,上海200040

出　　处：《创伤外科杂志》2017年第12期936-939,共4页Journal of Traumatic Surgery

基　　金：上海市卫生局面上基金(2009037)

摘　　要：目的观察不同营养状态老年股骨转子间骨折行股骨近端抗旋髓内钉(PFNA)内固定治疗患者围术期隐性失血情况。方法回顾性分析2014年8月—2015年8月复旦大学附属华东医院接诊的90例股骨转子间骨折老年患者。按照微型营养评价法评分分为对照组(营养良好)、研究1组(潜在营养不良)、研究2组(营养不良),每组30例。其中对照组男性19例,女性11例;年龄70~90岁,平均77.1岁;研究1组男性18例,女性12例;年龄71~90岁,平均79.0岁;研究2组男性17例,女性13例;年龄70~91岁,平均78.9岁。所有患者均采用PFNA内固定进行治疗,记录3组患者术前术后的血清学指标[总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRA)、淋巴细胞百分比(TLP)、淋巴细胞计数(TLC)、血红蛋白(Hb)],采用面积法检测血液浸润面积进而检测患者失血量,并计算高、低隐性失血量患者的术前术后血清学指标,并对结果进行比较。结果术前,研究2组患者的血清学指标明显低于研究1组和对照组;术后,3组患者的血清指标均有所下降,而研究2组患者的血清学指标明显低于研究1组和对照组,差异有统计学意义(P<0.05)。研究2组患者的总失血量、隐性失血量以及高隐性失血量病例数明显多于对照组和研究1组,术后血细胞比容(HCT)明显低于对照组和研究1组,3组高隐性失血量比较差异有统计学意义(P<0.05)。术后,3组患者的TP、ALB、PA、TRA、TLP、TLC、Hb等血清指标与术前比较,均有下降,而高隐性失血组患者下降较为明显,与术前比较,差异有统计学意义(P<0.05);术后,高隐性失血组患者的各指标明显低于低隐性失血组患者,差异有统计学意义(P<0.05)。结论随着营养状况的恶化,老年股骨转子间骨折患者的失血量以及高隐性失血率逐渐增多,其中TP、ALB等血清学指标可以作为老年股骨转子间骨折患者隐性失血的检测指标。Objective To observe the perioperative hidden blood loss in patients with intertrochanteric fracture treated by PFNA internal fixation with different nutritional status.Methods Ninety elderly patients with intertrochanteric fractures admitted to Huadong Hospital Affiliated to Fudan University from Aug.2014 Aug.2015 were retrospectively analyzed.According to the mini-nutritional evaluation method,the patients were divided into control group（well nourished）,study group 1（potential malnutrition）,and study group 2（malnutrition）,with 30 cases in each group.All patients were treated with PFNA fixation.Serum indexes before and after surgery（total protein（TP）,albumin（ALB）,prealbumin（PA）,transferrin（TRA）,lymphocyte percentage（TLP）,lymphocyte count（TLC）,hemoglobin（Hb））,blood loss,and preoperative and postoperative serological indicators of hidden blood loss were recorded,and the results were compared.Results Before operation,the serological indexes of the study group 2 were significantly lower than those of the study group 1 and the control group.After operation,the serum indexes of the three groups were decreased,and the serological indexes of the study group 2 were significantly lower than those of the study group 1 and the control group（P0.05）.The total blood loss,the amount of hidden blood loss and the number of cases with high hidden blood loss were significantly larger in the study group 2 than those in the control group and the study group 1（P0.05）.After operation,such indexes as TP,ALB,PA,TRA,TLP,TLC,Hb of the study groups were decreased compared with those before operation,and the indexes of the study group 2 were significantly lower than those in the control group and the study group 1,and the difference was statistically significant（P0.05）.Compared with the preoperative group,the difference was statistically significant（P0.05）.After operation,the serological indexes of the patients with high hidden blood loss were lower than those of the patients with l

关 键 词：股骨转子间骨折 营养 内固定 隐性失血 老年 

分 类 号：R683.42[医药卫生—骨科学]