老年髋部骨折患者围手术期输血和危险因素

目的 评估老年髋部骨折患者围手术期异体红细胞输血(allogeneic red blood cell transfusions,ABT)的需求及不同因素对ABT的影响。方法 对2019年1月至2019年12月期间因髋部骨折入住北京积水潭医院老年创伤骨科病房行手术治疗的1 112例老年(≥65岁)患者进行了研究。收集患者围手术期的资料,用单因素和多因素逐步Logistic回归分析,确定老年髋部骨折患者围手术期ABT的危险因素。结果 1 112例患者中50.6%(563例)的患者围手术期有ABT记录。单因素分析显示:老年髋部骨折患者围手术期ABT组的患者年龄更大、术中出血量(intraoperative blood loss,IBL)更多,体质量指数(body mass index,BMI)、入院血红蛋白(hemoglobin,Hb)及血清白蛋白(albumin,ALB)更低,凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)更长,手术持续时间更短,女性、股骨粗隆间骨折、美国麻醉医师协会(American Association of Anesthesiologists,ASA)分级≥Ⅲ级、全身麻醉和不合并糖尿病的患者所占比例更高。多因素逐步Logistic回归分析提示:入院Hb低、股骨粗隆间骨折、IBL多、高龄、BMI低、ASA分级≥Ⅲ级和全身麻醉是老年髋部骨折患者围手术期ABT的独立危险因素。结论 老年髋部骨折患者围手术期ABT很常见,ABT与入院Hb低、股骨粗隆间骨折、IBL多、高龄、BMI低、ASA分级≥Ⅲ级和全身麻醉相关,可以从这几个方面来考虑降低围手术期ABT,针对不可变的危险因素则需早期充分备血。

Perioperative blood transfusion and risk factors in elderly patients with hip fracture

Objective To evaluate the needs for perioperative allogeneic red blood cell transfusions (ABT) in elderly patients with hip fracture and the influence of different factors on ABT. Methods We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital from January 2019 to December 2019 due to hip fracture. The perioperative data of the patients were collected, and univariate and multivariate stepwise Logistic regression analysis were performed to determine the risk factors for perioperative ABT. Results A total of 1 112 patients were included in this study, 50.6% of whom had a perioperative ABT. Univariate analysis showed that elderly patients with hip fracture in the perioperative ABT group were older, had more intraoperative blood loss (IBL), lower body mass index (BMI), lower hemoglobin and serum albumin at admission, longer prothrombin time (PT) and activated partial thromboplastin time (APTT), and shorter operative time. Female, intertrochanteric fractures, American Society of Anesthesiologists (ASA) classification ≥ Grade Ⅲ, general anesthesia, and patients without diabetes were more common. Multivariate stepwise Logistic regression analysis indicated that low hemoglobin at admission, intertrochanteric fracture, high IBL, advanced age, low BMI, ASA classification ≥Grade Ⅲ and general anesthesia were independent risk factors for perioperative ABT in elderly patients with hip fracture. Conclusion Perioperative ABT is very common in elderly patients with hip fracture. It is associated with low Hb at admission, intertrochanteric fracture, high IBL, advanced age, low BMI, ASA classification≥Grade Ⅲ and general anesthesia. These aspects can be considered to reduce perioperative ABT. Early and adequate blood preparation is required for the patients with immutable risk factors.