青少年特发性脊柱侧凸矫形手术患者围手术期出血情况及影响因素分析  

Analysis of perioperative bleeding status and its influencing factors in patients with adolescent idiopathic scoliosis undergoing orthopedic surgery

作　　者：沈珊 刘鹏飞 方慢 周姗姗 胡成云 代飞彪 李雪[3] 唐朝亮 SHEN Shan;LIU Peng-fei;FANG Man;ZHOU Shan-shan;HU Cheng-yun;DAI Fei-biao;LI Xue;TANG Chao-liang(Department of Blood Transfusion,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei,Anhui 230001,China;Department of Spinal Surgery,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei,Anhui 230001,China;Department of Anesthesiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei,Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院输血科,安徽合肥230001 [2]中国科学技术大学附属第一医院脊柱外科,安徽合肥230001 [3]中国科学技术大学附属第一医院麻醉科,安徽合肥230001

出　　处：《颈腰痛杂志》2024年第1期107-111,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：安徽省自然科学基金(编号:2208085Y32);湖北陈孝平科技发展基金会基金(编号:CXPJJH12000005-07-115)。

摘　　要：目的分析青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫形手术患者围手术期出血情况及影响因素。方法选取2015年2月~2022年9月于中国科学技术大学附属第一医院接受手术治疗的105例AIS患者为研究对象,均接受脊柱侧弯后路矫形手术。记录患者围手术期显性失血量和隐性失血量,采用多元线性回归分析影响AIS矫形围手术期出血的相关因素。结果全部患者均顺利完成手术,围手术期平均总失血量为(456.32±142.30)mL,其中平均显性失血量为(255.00±101.26)mL,平均隐性失血量为(201.33±63.07)mL,分别占总失血量的55.88%和44.12%。相关性分析显示,AIS矫形手术患者围手术期总失血量、显性失血量及隐性失血量与体重、术前Cobb角、术后Cobb角、矫正Cobb角、手术时间、融合节段数、截骨、术中使用氨甲环酸、术后引流量有关(P<0.05),总失血量、隐性失血量还与性别有关(P<0.05);多元线性回归分析显示,截骨、术中使用氨甲环酸是影响围手术期出血的主要因素(P<0.05),此外,性别是影响总失血量及隐性失血量的主要因素,体重、术前Cobb角是影响总失血量的因素。结论AIS矫形手术患者围手术期隐性失血量所占比例较高,其中截骨患者发生围手术期出血的风险明显上升,术中使用氨甲环酸的患者发生围手术期出血的风险明显下降,男性总失血量及隐性失血量均增加。Objective To analyze the perioperative bleeding status and its influencing factors in patients with adolescent idiopathic scoliosis(AIS)undergoing orthopedic surgery.Methods A total of 105 patients with AIS who received surgical treatment in the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China were selected as the study subjects from February 2015 to September 2022.All patients underwent posterior orthopedic surgery for scoliosis.The perioperative dominant blood loss volume and hidden blood loss volume were recorded,and multivariate linear regression analysis was used to analyze the related factors affecting perioperative bleeding in patients with AIS orthopedic surgery.Results All patients successfully completed the surgery.The average total perioperative blood loss volume was(456.32±142.30)mL,and the average dominant blood loss volume and average hidden blood loss volume was(255.00±101.26)mL and(201.33±63.07)mL,respectively,accounting for 55.88% and 44.12% of the total blood loss volume respectively.Correlation analysis showed that the total perioperative blood loss volume,dominant blood loss volume and hidden blood loss volume in patients with AIS orthopedic surgery were related to body weight,preoperative Cobb angle,postoperative Cobb angle,corrected Cobb angle,surgical time,number of fusion segments,osteotomy,intraoperative use of tranexamic acid and postoperative drainage volume(P<0.05),and total blood loss volume and hidden blood loss volume were also related to gender(P<0.05).Multivariate linear regression analysis revealed that osteotomy and intraoperative use of tranexamic acid were the main factors affecting perioperative bleeding(P<0.05).In addition,gender was the main factor affecting total blood loss volume and hidden blood loss volume.Body weight and preoperative Cobb angle were the factors affecting total blood loss volume.Conclusion The proportion of perioperative hidden blood loss volume is high in patients undergoing AIS o

关 键 词：青少年特发性脊柱侧凸 围手术期 隐性失血 影响因素 

分 类 号：R682.13[医药卫生—骨科学]