优化出血管理模式对颈椎后路椎管扩大成形术围手术期失血量的影响  

Effects of optimized bleeding management mode on perioperative blood loss after posterior cervical laminoplasty

作　　者：唐骞 陈峰[2] 翟吉良[2] 胡建华[2] 仉建国[2] TANG Qian;CHEN Feng;ZHAI Jiliang;HU Jianhua;ZHANG Jianguo(Department of Orthopaedics,Guizhou Provincial Orthopaedics Hospital,Guiyang 550014;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]贵州省骨科医院骨科,贵阳550014 [2]中国医学科学院北京协和医学院北京协和医院骨科,北京100730

出　　处：《中华骨与关节外科杂志》2023年第11期1033-1039,共7页Chinese Journal of Bone and Joint Surgery

基　　金：北京市自然科学基金(Z200025);贵阳市科技计划项目[筑科合同(2019)-9-14-17号];贵阳市白云区科技计划项目[白科合同(2020)3号]。

摘　　要：目的:探讨优化出血管理模式对颈椎后路椎管扩大成形术围手术期失血量的影响。方法:回顾性分析2018年6月至2022年5月进行颈椎后路椎管扩大成形术的216例患者的临床资料。手术节段为C3-7,根据是否采用优化出血管理模式将216例患者分为优化组(n=123)和传统组(n=93),比较两组患者术中出血量、术后第1、2、3天引流量、术后总引流量、插管时间、术后3 d内血红蛋白水平下降值、输血率、术后住院时间,以及术后切口感染、皮下积液、脑脊液漏、症状性硬膜外血肿等并发症发生情况。结果:优化组患者术中出血量、术后第1天引流量、术后总引流量均较传统组患者少,术后3 d内血红蛋白水平下降值较传统组患者低,插管时间、术后住院时间均较传统组患者缩短,切口愈合不良及症状性硬膜外血肿的发生率均低于传统组患者,且差异均有统计学意义(P<0.05)。结论:优化出血管理模式可减少颈椎后路椎管扩大成形术中出血量及总引流量,缩短插管时间,减少并发症发生率,并缩短住院时间。Objective:To explore the effect of optimizing the bleeding management mode on blood loss during posterior cervical laminoplasty.Methods:A retrospective analysis was conducted on 216 patients who underwent posterior cervical laminoplasty from June 2018 to May 2022,with the surgical segments from C3 to C7.The patients were divided into an optimization group(123 cases)and a control group(93 cases)based on whether an optimized bleeding management model was used.Intraoperative bleeding volume,postoperative drainage volume on day 1,2,and 3,total drainage volume,and days of drainage tube removal were compared between the two groups.The decreases in hemoglobin,blood transfusion rate,and postoperative hospitalization days were recorded and compared.The incidences of postoperative complications such as incision infection,cerebrospinal fluid leakage,and symptomatic epidural hematoma were recorded and compared between the two groups.Results:The optimization group showed significantly less intraoperative bleeding volume,first day postoperative drainage volume,total drainage volume,extubation days,postoperative hemoglobin decrease,and postoperative hospitalization days(P<0.05).The incidence of poor incision healing and symptomatic epidural hematoma was lower in the optimization group than in the control group,and these differences were statistically significant(P<0.05).Conclusions:Optimizing the bleeding management mode during the perioperative period can reduce the amount of intraoperative bleeding and total drainage volume,shorten the number of tube removal days,reduce the incidence of complications,and shorten hospital stay in patients undergoing posterior cervical laminoplasty.

关 键 词：失血量 加速康复外科 围手术期管理 颈椎后路椎管扩大成形术 

分 类 号：R681.5[医药卫生—骨科学]