PFNA 内固定手术老年患者围手术期隐性失血状况研究

目的：对采取股骨近端防旋髓内钉（ PFNA）内固定方法治疗的老年股骨转子间骨折的围术期隐性出血量进行分析，为临床处理提供必要的数据支撑。方法回顾性分析该院在2010年3月至2014年3月，采取PFNA治疗的80例股骨转子间骨折患者，其中男43例，女37例，平均年龄77．8岁。使用Gross方程，根据身高、体重和手术前后的红细胞比容（ HCT）变化，计算围手术期隐性失血量。结果80例患者中围手术期未输血的62例，男34例，女28例；平均年龄78．2岁；平均手术时间43．71 min；术中失血及术后引流量116．30 mL。术前血红蛋白（ Hb）平均111．3 g· L－1，术后84．6 g· L－1，降低了26．7 g· L－1；术前红细胞比容（HCT）平均36．27％，术后27．13％，降低了9．14％。采取输血支持的18例，男9例，女9例；平均年龄76．5岁；平均手术时间46．42 min；术中失血及术后引流量共111．24 mL；平均输血量574．22 mL。术前Hb平均98．2 g· L－1，术后95．7 g· L－1，降低了2．5 g· L－1；术前HCT平均29．87％，术后29．15％，降低了0．72％。按Gross方程计算，两组围手术期失血量分别为763．07 mL和631．68 mL，其中隐性失血量分别占84．76％和82．39％。结论 PFNA内固定治疗老年股骨转子间骨折患者围手术期隐性失血量较多，临床上应特别重视并严格注意术后患者生命体征的变化，以减少并发症的发生。

Study of hidden blood loss situation in perioperative period of elderly patients with PFNA

Objective To analyze the perioperative hidden blood loss during treatment of the intertrochanteric fracture in elderly pa-tients with proximal femoral nail anti-rotation( PFNA) so as to provide necessary data for clinical treatment.Methods A retrospective case series of 80(male 43,female 37)patients with an average age of 77.8 years,operated between March 2010 and March 2014 was re-viewed.The perioperative hidden blood loss was calculated by Gross formula,on according to the changes of height,weight and erythro-cyte hematocrit(HCT)before and after surgery.Results There were 62 cases(male 34,female 28)in the non-blood transfusion group with mean age of 78.2 years.The mean hemoglobin(Hb)value pre-op was 111.3 g· L-1 and post-op 84.6 g· L-1(decrease 26.7 g· L-1),and the mean HCT value was 36.27%preoperatively and 27.13% postoperatively(decrease 9.14%),respectively.There were 18 patients(male 9,female 9)in the blood transfusion group with mean age of 76.5 years.The mean blood transfusion volume was 574. 22 mL.The mean Hb value was 98.2 g· L-1 preoperatively and 95.7 g· L-1 postoperatively(decrease 2.5 g· L-1 ),the mean HCT value was 29.87%and 29.15%( decrease 0.72%) ,respectively.The calculated mean total blood loss was 631.38 mL with observed loss during operation and drainage 111.24 mL.The hidden blood loss was 763.07 mL in non-transfusion group and 631.68 mL in trans-fusion group,which was about 6 times greater than the observed blood loss,and occupied about 80% of the total blood loss volume. Conclusion The amount of perioperative hidden blood loss of intertrochanteric fracture in elderly patients with PFNA treatment is more,we should pay special attention to the vital signs of postoperative patients,so as to reduce the complications and help them safety through perioperative.