老年股骨粗隆间骨折手术隐性失血的危险因素分析

发布时间：2018-06-21 20:00

  本文选题：股骨粗隆间骨折 + 隐性失血　； 参考：《中国矫形外科杂志》2015年22期

【摘要】：[目的]探讨老年股骨粗隆间骨折手术治疗中影响隐性失血量的相关危险因素,提高对隐性失血的认识,为临床股骨粗隆间骨折围手术期治疗提供参考。[方法]回顾性分析本院2009年1月~2014年10月205例股骨粗隆间骨折患者临床资料,其中符合纳入标准,并获得完整病史资料有115例。隐性失血量通过手术前后红细胞压积变化,使用Gross方程,根据身高、体重和手术前后的红细胞压积(HCT)变化计算获得,对患者性别、年龄、是否存在基础疾病(高血压、糖尿病)、骨折类型、内固定方式、麻醉方式,受伤至手术时间,术前6个月内是否服用抗血小板药物,术后使用抗凝药物进行统计分析,筛选出差异有统计学意义的因素,然后以隐性失血量为因变量,以各影响因素为自变量,进行多元线性回归分析隐性失血的危险因素。[结果]患者术中显性失血量为(210.12±171.34)ml,隐性失血量为(583.19±117.54)ml。单因素分析结果显示,不同内固定方式、骨折类型、麻醉方式、术前使用抗血小板或术后使用抗凝药物隐性失血量差异显著(P≤0.05),多重线性回归分析结果显示,对隐性失血量有显著影响的因素有内固定方式、骨折类型、麻醉方式、抗凝药物应用。[结论]隐性失血是老年股骨粗隆间骨折手术失血的主要原因,造成隐性失血的危险因素有内固定方式、骨折类型、麻醉方式、抗凝药物运用;临床治疗中,将显性失血量作为补液、输血的依据不可靠,要充分考虑隐性失血的存在,应尽早干预,预防并发症发生。
[Abstract]:[objective] to explore the risk factors influencing the occult blood loss in the surgical treatment of intertrochanteric fracture of the femur, and to improve the understanding of the occult blood loss, and to provide a reference for the perioperative treatment of intertrochanteric fracture of the femur. [methods] the clinical data of 205 patients with intertrochanteric fracture of femur from January 2009 to October 2014 were retrospectively analyzed. Recessive blood loss was calculated by using Gross's equation, based on the changes of height, weight and HCT before and after surgery, to determine whether there were underlying diseases (hypertension) in patients' sex, age, and whether there were underlying diseases (hypertension). Diabetes mellitus, fracture type, internal fixation, anesthesia, time from injury to operation, whether or not to take antiplatelet drugs within 6 months before operation and anticoagulant drugs after operation were statistically analyzed. Then, the risk factors of recessive blood loss were analyzed by multivariate linear regression analysis, taking recessive blood loss as dependent variable and influencing factors as independent variables. [results] the apparent blood loss and recessive blood loss were 210.12 卤171.34 ml and 583.19 卤117.54 ml respectively. The results of univariate analysis showed that there were significant differences in internal fixation, fracture type, anesthesia, the amount of recessive blood loss before or after operation with antiplatelet or anticoagulant drugs (P 鈮，

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