颈椎前路融合手术隐性失血量的影响因素分析  

Hidden blood loss in anterior cervical fusion surgery: an analysis of risk factors

作　　者：杨嘉飞 尚显文[1] YANG Jia-fei;SHANG Xian-wen(Guizhou Medical University,Guiyang,Guizhou,550001,China)

机构地区：[1]贵州医科大学

出　　处：《中国骨与关节杂志》2019年第10期738-741,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨颈椎前路手术中影响隐性失血量的相关危险因素。方法回顾性分析2013年1月至2017年12月,我院收治的47例行颈椎前路椎间盘切除减压椎间植骨融合钢板螺钉内固定手术的患者。其中男23例,女24例;年龄30~81岁,平均49岁。其中行单一节段手术的患者33例,行双节段手术的患者14例。手术时间<180 min的患者29例,≥180 min的患者18例。术前存在基础疾病(高血压、糖尿病、肾病)的患者14例,无基础疾病的患者33例。术中失血量通过吸引瓶和纱布上的血液量总和进行计算;隐性失血量通过统计入院和术后第2天或者第3天血常规结果运用Gross公式进行计算。结果患者术中显性失血量为(191±169)ml,隐性失血量为(375±139)ml。单因素分析结果显示,单节段融合手术患者的隐性失血量为(345±127)ml,小于双节段融合手术患者的(444±146)ml,差异有统计学意义(P<0.05);手术时间<180 min患者的隐性失血量为(343±161)ml,小于手术时间≥180 min患者的(426±70)ml,差异有统计学意义(P<0.05);而性别、年龄、BMI及是否合并基础疾病对隐性失血量的影响无统计学意义。结论隐性失血是颈椎前路手术失血的主要原因,造成隐性失血的危险因素有手术节段的多少及手术时间。临床治疗中,将单纯显性失血量作为输血的依据并不准确,要充分考虑隐性失血的存在,应尽早干预,减少并发症发生率及病死率。Objective To investigate associated risk factors influencing the hidden blood loss in anterior cervical fusion surgery,and to enhance the understanding of blood transfusion after cervical spine surgery.Methods From January 2013 to December 2017,clinical data of 47 patients undergoing anterior cervical discectomy and fusion were analyzed.There were 23 males and 44 females,aging 30-81 years(mean:49 years).Single-segment fusion surgery was used in 33 cases and double-segment fusion surgery in 14 cases.There were 29 patients with operative time less than 180 minutes and 18 patients longer than 180 minutes.Fourteen patients had underlying diseases(hypertension,diabetes,kidney disease)before surgery,while 33 patients not.Intraoperative blood loss was obtained by summing the amount of blood in suction containers and soaked sponges.The amount of hidden blood loss was calculated by preoperative red blood cell volume and postoperative day 2 or 3.Results The intraoperative visual blood loss was(191±169)ml and the hidden blood loss was(375±139)ml.Univariate analysis showed that the amount of hidden blood loss in patients with single-segment fusion surgery was(345±127)ml,which was less than doublesegment fusion surgery(444±146)ml(P<0.05);the amount of hidden blood loss in patients with operative time less than 180 minutes was(343±161)ml,which was less than the operation time of more than 180 minutes(426±70)ml(P<0.05);there were no statistical differences on gender,age,BMI and underlying diseases.Conclusions Hidden blood loss is the main cause in anterior cervical spine surgery blood loss.Risk factors of hidden blood loss include the number of surgical segments and the operation time.In clinical treatment,simple dominant blood loss is not accurate.Hidden blood loss should be considered as early as possible to prevent complications and mortality.

关 键 词：颈椎手术 隐性失血 红细胞比积 

分 类 号：R687.3[医药卫生—骨科学]