老年患者髋关节手术术后输血危险因素分析  

Risk factors for postoperative allogenic blood transfusion after unilateral hip surgery in elderly patients

作　　者：薄晗 朱慧杰 汪文文 许碧云[3] 马正良[1] Bo Han;Zhu Huijie;Wang Wenwen;Xu Biyun;Ma Zhengliang(Department of Anesthesiology,Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University,Nanjing 210008,China;Department of Anesthesiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Research,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学附属鼓楼临床医学院麻醉科,210008 [2]南京大学医学院附属鼓楼医院麻醉科,210008 [3]南京大学医学院附属鼓楼医院科研部,210008

出　　处：《国际麻醉学与复苏杂志》2020年第7期646-650,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家重点研发项目(SQ2018YFC200044);国家自然科学基金(81971044,81671087);江苏省卫生厅资助项目(江苏省重点课题ZDXKA2016018)。

摘　　要：目的筛选行单侧髋关节手术的老年患者术后输血的危险因素。方法回顾性分析2013年6月—2019年5月于南京鼓楼医院择期行单侧髋关节手术且年龄≥65岁的患者959例。收集患者基本情况、并存疾病、手术类型、术中用药、术中监测、术后输血等信息,进行单因素分析和多元逻辑回归分析,以识别术后输血的独立危险因素。结果共109例(11.4%)患者术后输血。术前贫血(P<0.01)、翻修手术(P=0.01)、术中失血量≥6.67 ml/kg(P<0.05)是老年患者髋关节手术术后输血的独立危险因素,术中使用氨甲环酸(P<0.01)、术中体温监测(P=0.027)则是保护因素。结论积极纠正患者术前贫血,术中使用氨甲环酸,关注围手术期体温保护可能有效减少老年髋关节手术患者术后输血的发生,从而避免或降低输血相关并发症的发生,缩短患者住院时间。Objective To screen the risk factors of postoperative blood transfusion in elderly patients undergoing unilateral hip surgery.Methods A retrospective study was conducted and 959 consecutive patients(aged≥65 years)undergoing unilateral hip surgery at Nanjing Drum Tower Hospital from June 2013 to May 2019 were enrolled.In order to identify the independent risk factors of postoperative blood transfusion,this study collected patients'basic information,co-existing diseases,types of operation,intraoperative medication,intraoperative monitoring method,postoperative blood transfusion and other information to perform single factor analysis and multiple logistic regression analysis.Results A total of 109 patients(11.4%)received blood transfusion.Preoperative anemia(P<0.01),hip revision operation(P=0.010)and amount of intraoperative blood loss≥6.67 ml/kg(P<0.01)were the independent risk factors of postoperative blood transfusion in elderly patients undergoing unilateral hip surgery.When using tranexamic acid during operation(P<0.01),intraoperative temperature monitoring(P=0.027)were the protective factors.Conclusions Actively correcting preoperative anemia,using tranexamic acid during operation,and paying extensive attention to intraoperative temperature management may effectively reduce the incidence of postoperative allogenic blood transfusion after unilateral hip surgery in elderly patients.Thus,they are beneficial to avoid or reduce the occurrence of allogenic transfusion-related complications,and shorten the length of stay.

关 键 词：术后输血 老年人 髋关节手术 

分 类 号：R687.4[医药卫生—骨科学]