老年髋部骨折术后低钙血症与隐性失血量的相关性研究  

Correlation between Postoperative Hypocalcemia and Postoperative Blood Loss in Elderly Patients With Hip Fracture

作　　者：白颖[1] 于淼淼 金丽鲜 李智敏 李华杰 孔月月 周宁[1] Bai Ying;Yu Miaomiao;Jin Lixian;Li Zhimin;Li Huajie;Kong Yueyue;Zhou Ning(Department of Critical Care Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院重症医学科,北京100035

出　　处：《实用骨科杂志》2023年第7期609-613,共5页Journal of Practical Orthopaedics

基　　金：北京市属医院科研培育计划(PX2022014)。

摘　　要：目的探讨术后低钙血症对老年髋部骨折患者术后隐性失血量及输血比例的影响。方法前瞻性分析2022年1月至2023年1月在北京积水潭医院术后转入ICU的老年髋部骨折患者,共148例患者纳入研究,其中男51例,女97例;年龄67~97岁,平均(84.3±8.1)岁。根据白蛋白校正血钙浓度,校正后血钙低于2.11 mmol/L定义为低钙血症。148例转入ICU的患者中发生低钙血症74例(50.0%)。在术后转入ICU即刻采集血样,记录术后及术后第2天的血钙、血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit,HCT)、白蛋白、Charlson合并症指数(Charlson comorbidity index,CCI)、术后输血量,根据公式计算患者术后2 d内的隐性失血量,采用一元及多元线性回归进一步分析引起术后失血量增加的危险因素。结果低钙组和正常组的Hb及HCT变化差异无统计学意义。低钙组的输血比例(87.8%)明显高于正常组(51.4%),P<0.001。低钙组的隐性失血量为523.8(159.6,993.8)mL,显著高于正常组357.3(80.7,594.8)mL,P=0.005。低钙组的输血量为400(400,400)mL,显著高于正常组200(0,400)mL,P<0.001。低钙组ICU住院时间明显长于正常组(P=0.043)。术后失血量增加相关的独立危险因素为骨折类型(股骨转子间骨折)、输血量、低钙血症(P<0.05)。结论术后低血钙患者隐性失血量显著增高,输血率及输血量更高,且显著延长ICU住院时间。骨折类型(转子间骨折)和低钙血症是术后失血量增多的独立危险因素,提示临床医生应关注术后低钙血症,注意术中钙离子的补充,优化老年髋部骨折患者围手术期的管理。Objective To investigate the effect of postoperative hypocalcemia on the postoperative occult blood loss and blood transfusion ratio in elderly patients with hip fractures.Methods We collected elderly patients with hip fractures who were transferred to ICU after surgery at Beijing Jishuitan Hospital from January 2022 to January 2023.A total of 148 patients were included in the study,including 51 males and 97 females.The patient age ranged from 67 to 97 years,with an average age of(84.3±8.1)years.We corrected blood calcium concentration based on albumin.Blood calcium below 2.11 mmol/L was defined as hypocalcemia.50%of the patients transferred to ICU(148 cases)developed hypocalcemia(74 cases).Blood samples(hemoglobin and hematocrit)were collected immediately after the patient was transfered to the ICU after surgery,and blood transfusion volume during and two days after surgery was recorded.According to the calculation formula,the patient’s implicit blood loss within two days after surgery was calculated.Single factor and multiple factor linear regression were used to further analyze risk factors.Results A total of 148 patients were included.There was no significant difference in hemoglobin and hematocrit between the hypocalcemia group and the normal group.The blood transfusion ratio in the low calcium group(87.8%)was significantly higher than that in the normal group(51.4%),P<0.001.The occult blood loss in the low calcium group was 523.8(159.6,993.8)mL,which was significantly higher than the 357.3(80.7,594.8)mL in the normal group(P=0.005).The blood transfusion volume in the normal group was 200 mL(0,400).The blood transfusion volume in the hypocalcemia group was 400 mL(400,400)mL,which was significantly higher than that in the normal group(P<0.001).The ICU hospitalization time in the low calcium group was significantly longer than that in the normal group(P=0.043).Analysis of risk factors related to postoperative occult blood loss showed that the independent risk factors associated with increased postoperative

关 键 词：高龄 髋部骨折 低钙血症 隐性失血 输血 

分 类 号：R683.3[医药卫生—骨科学]