伴和不伴类风湿性关节炎患者腰椎管狭窄后路减压融合过程中隐性失血的对比  

Hidden blood loss during posterior lumbar interbody fusion in lumbar spinal stenosis patients with and without rheumatoid arthritis

作　　者：王晶[1] 徐帅[2] 刘海鹰[2] Wang Jing;Xu Shuai;Liu Haiying(Department of Anesthesia,Peking University People’s Hospital,Beijing 100044,China;Department of Spinal Surgery,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院麻醉科,北京市100044 [2]北京大学人民医院脊柱外科,北京市100044

出　　处：《中国组织工程研究》2020年第33期5307-5314,共8页Chinese Journal of Tissue Engineering Research

基　　金：产品临床研究(2016YFC0105606),项目参与人:徐帅。

摘　　要：背景:腰椎管狭窄症后路手术除术中出血和术后引流外,还存在大量的"隐性失血"。合并类风湿性关节炎患者可能会影响围术期出血尤其是隐性失血,此前并无报道。目的:针对合并类风湿性关节炎的腰椎管狭窄患者与非类风湿性关节炎行腰椎后路手术时术中出血量、术后引流量以及隐性失血情况进行对比,并探讨类风湿性关节炎患者隐性失血的危险因素。方法:回顾性纳入了65例合并类风湿性关节炎的腰椎管狭窄患者(类风湿性关节炎组),筛选87例未合并类风湿性关节炎的腰椎管狭窄患者(非类风湿性关节炎组),所有患者均采取椎弓根螺钉+钛棒+椎间融合器内固定系统进行腰椎后路减压融合和后外侧融合治疗,术中行自体骨后外侧植骨。提取信息包括人口统计学信息、类风湿性关节炎信息(如类风湿性关节炎病史、Steinbrocker分级、抗类风湿性关节炎药物)、手术信息以及出血量相关指标。以术中出血量、术后引流量和隐性失血作为主要指标;以手术时间、术前术后红细胞压积和血红蛋白及其变化值、手术前后贫血数量、术后新发贫血数量、自体血和异体血输注量等作为次要指标。结果与结论:①类风湿性关节炎组腰椎管狭窄患者平均年龄为(65.97±8.02)岁,平均体质量指数为(25.76±3.68)kg/m^2,非类风湿性关节炎组中患者在性别比例、年龄和手术节段数上均与之匹配;②类风湿性关节炎组中患者平均病程为(16.78±12.73)年,其中单药或联合口服改变病情抗风湿药者最常见,2组在椎弓根螺钉数和椎间融合器置入数量上差异均无显著性意义,围术期并发症发生率2组差异亦无显著性意义;③主要结果对比显示2组在总失血量、术中出血量和术后引流量方面差异无显著性意义,而隐性失血以及隐性失血所占总失血量比例在非类风湿性关节炎组中更低(P<0.001,0.012);根据手术节段数BACKGROUND: In addition to intraoperative bleeding and postoperative drainage after posterior approach for lumbar spinal stenosis, there is a large amount of hidden blood loss. Patients combined with rheumatoid arthritis may affect perioperative bleeding, especially hidden blood loss, which has not been reported before. OBJECTIVE: To compare intraoperative blood loss, postoperative drainage and hidden blood loss of posterior lumbar interbody fusion on lumbar spinal stenosis in patients with rheumatoid arthritis and non-rheumatoid arthritis and identify the risk factors of hidden blood loss in patients with rheumatoid arthritis. METHODS: Totally 65 patients diagnosed as lumbar spinal stenosis with rheumatoid arthritis(rheumatoid arthritis group) and 87 patients without rheumatoid arthritis(non-rheumatoid arthritis group) were retrospectively enrolled. All patients were treated with posterior decompression fusion and posterolateral fusion with internal fixation system of pedicle screw + titanium rod + interbody fusion cage. Posterolateral autogenous bone grafting was performed during the operation. The extracted measures included demographic characteristics, rheumatoid arthritis-related parameters such as rheumatoid arthritis duration, Steinbrocker classification and anti-rheumatoid arthritis drugs as well as information on operation and blood loss. Intraoperative blood loss, postoperative drainage and hidden blood loss were the primary outcomes. The secondary measures included operation time, preoperative and postoperative hematocrit and hemoglobin, the number of anemia pre-and post-operatively, autologous blood and allogeneic blood transfusion. RESULTS AND CONCLUSION:(1) The mean age and bone mass index were(65.97±8.02) years and(25.76±3.68) kg/m^2 of patients in rheumatoid arthritis group. The gender ratio, age and number of surgical segments were all matched between the rheumatoid arthritis and non-rheumatoid arthritis groups.(2) The mean duration was(16.78±12.73) years in the rheumatoid arthritis group, of

关 键 词：骨 类风湿性 关节炎 腰椎管狭窄 腰椎 减压融合术 引流量 隐性失血 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]