老年人营养状况与髋部骨折术前隐性失血的相关性研究  

Correlation between preoperative hidden blood loss and nutritional status in elderly hip fracture patients

作　　者：刘国印[1] 贾小宝[1] 张勇[1] 王进[1] 朱冬梅[1] 鲍磊[1] 陈建民[1] LIU Guoyin;JIA Xiaobao;ZHANG Yong;WANG Jin;ZHU Dongmei;BAO Lei;CHEN Jianmin(Department of Orthopaedics, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing 210002, China)

机构地区：[1]南京中医药大学附属八一医院骨科,南京210002

出　　处：《中华骨与关节外科杂志》2018年第1期15-19,共5页Chinese Journal of Bone and Joint Surgery

基　　金：南京市科技计划项目(项目编号:201503007);南京军区科技创新项目(项目编号:14MS046)

摘　　要：背景:老年髋部骨折患者的预后与其营养状况密切相关,但髋部骨折术前营养状态对术前隐性失血的影响尚不明确。目的目的:研究老年髋部骨折患者入院时营养状况对术前隐性失血的影响。方法:对2010年3月至2015年3月收治的髋部骨折患者进行回顾性分析,入院时和术前均常规行血清实验室检查。根据MNA评分分为营养正常组、潜在营养不良组和营养不良组。根据患者身高、体重、入院时和术前红细胞压积,计算术前血容量和隐性失血量,按照术前隐性失血量占术前血容量比例分为低和高隐性失血量患者。比较各营养状况组间术前隐性失血量及其占术前血容量的比例的差异。结果结果:共纳入528例患者,平均年龄(77.6±9.5)岁。股骨转子间骨折组术前隐性失血量平均为(260.4±65.8)ml,明显高于股骨颈骨折组[(166.4±46.5)ml,P<0.05)]。股骨转子间骨折组术前隐性失血量占术前血容量比平均为6.3%±1.5%,显著高于股骨颈骨折组(4.0%±1.3%,P<0.05)。股骨颈骨折和转子间骨折术前隐性失血量数据分析:营养不良组>潜在营养不良组>营养正常组,营养状况各组间两两比较,差异均有统计学意义(P<0.05)。髋部骨折患者术前隐性失血量占术前血容量的比例和高隐性失血发生率均随着营养状况的恶化而逐渐升高,组间比较差异均有统计学意义(P<0.05)。结论结论:老年髋部骨折入院时营养状况是术前隐性失血发生的重要影响因素,可作为判断围手术期高隐性失血和预后的重要指标。Background： It is proven that prognosis is closely related to nutritional status in elderly patients with hip fractures. However, whether preoperative nutritional status affect preoperative hidden blood loss（HBL） is still unclear. Objecjective： To observe the effect of preoperative nutritional status on preoperative HBL in elderly patients with hip fractures. Meth Methods： We reviewed the patients with hip fracture treated between March 2010 and March 2015. Laboratory serological examination was performed on admission and before surgery. The patients were assigned to normal-nourishment group, malnourishment at risk group, and malnourishment group according the Mini Nutritional Assessment（MNA）. The original blood volume and preoperative HBL were calculated based on height, weight, Hct on admission and before surgery. According to the proportion of preoperative HBL on the original blood volume, patients were divided into low or high HBL group. Preoperative HBL and the proportion on the original blood volume were compared between groups. Results： Totally 528 patients with a mean age of（77.6±9.5） years were included. Preoperative HBL and the proportion of preoperative HBL on the original blood volume were（260.4 ± 65.8） ml and 6.3% ± 1.5% in femoral intertrochanteric fracture group, respectively, which were significantly higher than those in femoral neck fracture group（[166.4±46.5] ml, 4.0%±1.3%, P〈0.05）. In comparison of preoperative HBL data analysis： malnourishment group〉malnourishment at risk group〉normal-nourishment group; there were significant differences between any two groups（P〈0.05）. Preoperative HBL, its proportion on the original blood volume, and preoperative incidence of HBL were gradually increased with the deterioration of nutritional status, and there were significant differences between any two groups（P〈0.05）. Conclusions： Nutrition status had significant value in predicting the risk of preoperative high HBL and can be considered as an important

关 键 词：老年人 髋部骨折 营养状况 隐性失血 

分 类 号：R687.3[医药卫生—骨科学]