老年股骨颈骨折患者围手术期血细胞比容、血红蛋白和隐性失血的变化分析

目的探讨监测老年股骨颈骨折患者围手术期血细胞比容（HCT）、血红蛋白（HGB）和隐性失血的重要性。 方法选取北京老年医院2015年1月至2017年1月收治的老年股骨颈骨折患者36例，结合手术中使用假体类型分为骨水泥型组和生物型组，记录分析术前1 d、术后1、3、5、7 d的HCT、HGB和隐性失血量的变化，进行对照统计研究，并总结股骨颈骨折围手术期失血情况。 结果骨水泥型组与生物型组术前1 d、术后1、3、5、7 d的HCT和HGB分别为（34.82±4.76）% vs （35.76±4.49）%、（30.56±3.31）% vs （30.38±4.75）%、（29.86±3.57）% vs （28.99±3.86）%、（28.28±2.15）% vs （27.46±2.74）%、（29.13±2.11）% vs （28.63±3.97）%；（119.16±14.74）g/L vs （122.56±11.13）g/L、（100.95±10.49）g/L vs （100.14±14.40）g/L、（99.12±11.25）g/L vs （99.70±11.40）g/L、（99.00±6.46）g/L vs （97.17±13.47）g/L、（102.63±6.41）g/L vs （99.30±14.29）g/L]，2组比较差异均无统计学意义（P>0.05）。骨水泥型组HCT术后第5天达最低值，生物型组亦同。骨水泥型组HGB术后第5天到达最低值，生物型组亦同。术后1、3、5、7 d的骨水泥型隐性失血量低于生物型（670.25±358.12）ml vs （703.97±402.84）ml、（692.28±394.18）ml vs （741.75±456.25）ml、（549.16±322.52）ml vs （580.39±305.94）ml、（570.72±350.61）ml vs （624.60±355.60）ml]，术后第3天、第7天2组比较差异有统计学意义（t=-3.28，P=0.011；t=-3.337，P=0.04），术后第1天、第5天2组比较差异无统计学意义（P>0.05）。骨水泥型组术后第5天到达最低值，生物型组亦同。 结论股骨颈骨折患者围手术期失血量大于手术记录出血量，在临床工作中应当密切监测患者HCT、HGB变化值，估算出隐性失血量及围手术期失血量并及时给予相应治疗。

Perioperative blood loss in elderly patients with femoral neck fracture

ObjectiveTo evaluate the changes in hematocrit (HCT), hemoglobin (HGB), and hidden blood loss in patients with femoral intertrochanteric fracture. MethodsA retrospective analysis was performed on the clinical data for 36 elderly patients with femoral intertrochanteric fracture who were treated from January 2013 to December 2015. These patients were divide into either a bone-cement type group or a biological type group according to the type of prosthesis used in surgery, and HGB, HCT, and hidden blood loss were compared statistically. ResultsOne day preoperatively and 1, 3, 5, and 7 days postoperatively, the HCT and HGB in the bone-cement type and biological type groups were (34.82±4.76) vs (35.76±4.49), (30.56±3.31) vs (30.38±4.75), (29.86±3.57) vs (28.99±3.86), (28.28±2.15) vs (27.46±2.74), and (29.13±2.11) vs (28.63±3.97); and (119.16±14.74) g/L vs (122.56±11.13) g/L, (100.95±10.49) g/L vs (100.14±14.40) g/L, (99.12±11.25)g/L vs (99.70±11.40) g/L, (99.00±6.46) g/L vs (97.17±13.47) g/L, (102.63±6.41) g/L vs (99.30±14.29) g/L, respectively (P>0.05 for all). Both HCT and HGB reached the lowest on day 5 postoperatively in both groups. On days 1, 3, 5, and 7 postoperatively, the hidden blood loss in the bone-cement type and biological type groups was (670.25±358.12) mL vs (703.97±402.84) mL, (692.28±394.18) mL vs (741.75±456.25) mL, (549.16±322.52) mL vs (580.39±305.94) mL, (570.72±350.61) mL vs (624.60±355.60) mL, respectively; there was a significant difference on days 3 and 7 between the two groups (t=-3.28, P=0.011; t=-3.337, P=0.04), but not on days 1 and 7 (P>0.05). The hidden blood loss reached the lowest on day 5 postoperatively in both groups. ConclusionIn elderly patients with femoral intertrochanteric fracture, perioperative blood loss is greater than that recorded in surgery, and HGB and HCT should be closely monitored in these patients to estimate the hidden blood loss and perioperative blood loss and give corresponding treatment.