MIS-TLIF术的隐性失血情况及其风险因素分析  

Analysis of hidden blood loss in MIS-TLIF and its risk factors

作　　者：王沛 强晓军[1] 李原 杨光[1] WANG Pei;QIANG Xiao-jun;LI Yuan;YANG Guang(Department of Orthopaedics I,General Hospital of Puyang Oilfield,Puyang,Henan,457000,China)

机构地区：[1]濮阳市油田总医院骨一科,河南濮阳457000

出　　处：《颈腰痛杂志》2023年第2期162-166,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的观察腰椎退行性疾病患者行MIS-TLIF术后的隐性失血(hidden blood loss,HBL)情况,并分析风险因素。方法回顾性分析本科2019年3月~2021年12月开展MIS-TLIF手术的130例腰椎退行性疾病患者资料,收集其人口学特征、健康行为资料、基础疾病、手术相关指标、血液学指标和凝血指标等数据,对上述资料与术后HBL之间的相关性进行Pearson或Spearman分析,采用多元线性回归分析确定MIS-TLIF术后HBL增加的独立风险因素。结果130例患者术中可见失血量为90~287 mL,平均(182.3±76.9)mL;HBL 110~370 mL,平均(258.7±83.5)mL;HBL占总失血量的35%~76%,平均(58.6±11.3)%。相关性分析显示:年龄、手术时间、皮下脂肪厚度、肌肉厚度、ASA分级、总血容量(patient blood volume,PBV)、总失血量(total blood loss,TBL)、红细胞压积(hematocrit,Hct)减少量、血红蛋白(haemoglobin,Hb)减少量、融合节段数,均与HBL之间存在正相关性(均为P<0.001);纤维蛋白原水平、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)和术后Hb水平、术后Hct水平均与HBL之间呈显著的负相关性(均为P<0.001)。多元线性回归分析显示:年龄、肌肉厚度、ASA分级和PBV、TBL、Hct减少量均是MIS-TLIF术后HBL增加的独立风险因素(均为P<0.05);而纤维蛋白原水平和术后Hct水平则是其独立保护因素(均为P<0.05)。结论MIS-TLIF术后的HBL在总失血量中的比例较高,术后HBL增加的相关风险因素包括年龄、肌肉厚度、ASA分级和PBV、TBL、Hct减少量,而纤维蛋白原水平和术后Hct水平则是其独立保护因素。Objective To observe the hidden blood loss(HBL)in patients with degenerative lumbar spine diseases after MIS-TLIF,and to summarize the risk factors for the increase of HBL in patients after surgery.Methods The clinical data of 130 patients with degenerative lumbar spine diseases who underwent MIS-TLIF from March 2019 to December 2021 in our department were retrospectively analyzed.The data related to patients'demographic characteristics,health behavior data,underlying diseases,surgery-related indicators,hematological indicators and coagulation indicators were collected,and the correlation between the above data and postoperative HBL was performed by Pearson or Spearman analysis.Multiple linear regression analysis was used to determine independent risk factors for increased HBL after MIS-TLIF.Results Intraoperative visible blood loss in 130 patients ranged from 90 to 287 mL,with an average of(182.3±76.9)mL;HBL 110 to 370 mL,with an average of(258.7±83.5)mL;HBL accounted for 35%to 76%of total blood loss,with an average of(58.6±11.3)%.Correlation analysis showed that HBL was positively correlated with age,duration of surgery,subcutaneous fat thickness,muscle thickness,ASA classification,patient blood volume(PBV),total blood loss(TBL),hematocrit(Hct)reduction,haemoglobin(Hb)reduction,and number of fused segments(all P<0.001);HBL was negatively correlated with fibrinogen levels,activated partial thromboplastin time(APTT),postoperative Hb levels,and postoperative Hct levels(all P<0.001).Multiple linear regression analysis showed that age,muscle thickness,ASA classification and reduction in PBV,TBL and Hct were all independent risk factors for increased HBL after MIS-TLIF(all P<0.05),while fibrinogen level and postoperative Hct level were independent protective factors(all P<0.05).Conclusion The proportion of HBL to total blood loss after MIS-TLIF surgery is relatively high.Risk factors associated with increased postoperative HBL include age,muscle thickness,ASA classification,and decreased PBV,TBL,Hct.However,fibrin

关 键 词：MIS-TLIF 腰椎退行性疾病 隐性失血 风险因素 

分 类 号：R687.3[医药卫生—骨科学]