老年股骨粗隆间骨折髓内钉固定围手术期中隐性失血现象的病例对照研究

目的:分析髓内钉固定治疗老年股骨粗隆间骨折易被忽略的隐性失血现象,通过改善围手术期的治疗方式来保障临床疗效。方法:回顾性分析2010年1月至2014年1月采取髓内钉固定治疗的99例老年性股骨粗隆间骨折患者(男47例,女52例),其中围手术期采取输血支持47例(输血组),未输血患者52例(未输血组),根据Gross方程,用患者围手术期平均血红蛋白(Hb)、平均红细胞压积(HCT)来分析围手术期失血量,评估该类患者围手术期隐性失血情况。结果:未输血组(男22例,女30例)手术时间为(62.13±4.01) min,术中显性失血及术后引流量共215 ml;术前Hb(103.22±9.01) g /L,术后(81.13±6.20) g /L;术前HCT(96.93±3.38) I/L,术后(308.00±11.81) I/L.输血组(男25例,女22例)手术时间为(60.12±3.27) min,术中显性失血及术后引流量共196 ml,平均输血量621 ml;术前Hb(92.15±5.46) g /L,术后(95.20±8.93) g /L;术前HCT(96.52±3.63) I/L,术后(392.70±14.03) I/L.按Gross方程计算,未输血组和输血组围手术期失血总量分别为(937.29±63.04) ml和(706.43±35.02) ml,其中隐性失血量占较大比例。术后1、3个月,髋关节Harris评分输血组优于未输血组,术后12个月两组差异无统计学意义。结论:股骨粗隆间骨折髓内钉固定手术围手术期的隐性失血现象需引起足够重视,避免因贫血导致的围手术期并发症,影响患者预后。

Case-control study on hidden blood loss in perioperative period of femoral intertrochanteric fractures in elderly patients treated with intramedullary nailing

Objective:To analyze the neglected hidden blood loss before and after operations in the elderly patients with intertrochanteric fractures and strengthen the treatment and clinical nursing in the perioperative period in order to ensure clinical effects. Methods:The clinical data of 99 patients with intertrochanteric fracture treated with intramedullary nailing from January 2010 to January 2014 were retrospectively analyzed(47 males and 52 females). Forty-seven cases got blood transfusion supporting and 52 cases were not (blood transfusion group and no-blood transfusion group respectively). According to the Gross equation,the average hemoglobin(Hb) and hematocrit(HCT) were used to analyze blood loss in perioperative period and assess the patients' hidden blood loss situation. Results:There were 22 males and 30 females in blood transfusion group.The average operative time was(62.13±4.01) min;intraoperative visible blood loss and postoperative drainage were 215 ml,totally;preoperative Hb was (103.22±9.01) g /L and postoperative was (81.13±6.20) g/L;preoperative HCT was (96.93±3.38)I/L and postoperative was(308.00±11.81) I/L. There were 25 males and 22 females in no-blood transfusion group. The average operative time was (60.12±3.27) min;intraoperative visible blood loss and postoperative drainage were 196 ml,totally;the average blood transfusion were 621 ml;preoperative Hb was (92.15±5.46) g/L and preoperative was (95.20±8.93) g/L;preoperative HCT was (96.52±3.63) I/L and preoperative was (392.70±14.03) I/L. According to the Gross equation,the blood loss of no-blood transfusion group and blood transfusion group in peroperative period were (937.29±63.04) ml and(706.43±35.02) ml,respectively. The hidden blood loss was dominant. At 1,3 months after operation,Harris score of blood transfusion group was better than that of no-blood transfusion group,and 12 months after operation,there was no significant difference between two groups. Conclusion:The hidden blood loss of intramedullary nailing for intertrochanteric fracture should be emphasized in perioperative period,it can avoid the perioperative complications caused by anemia and affect the prognosis of patients.