股骨转子间骨折PFNA固定术后隐性失血及其相关因素的研究

发布时间：2018-04-05 10:39

本文选题：股骨转子间骨折　切入点：手术后出血　出处：《广州中医药大学》2015年硕士论文

【摘要】：目的：通过对采用股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)治疗的股骨转子间骨折患者进行各种失血量的分析,来验证其术后隐性失血的存在,并探讨隐性失血与各种影响因素之间的相关性,从而更好地指导临床。方法：采用前瞻性描述分析方法,对2013年01月至2015年02月期间在广东省中医院骨科病房住院,严格按照相关的诊断标准、纳入标准和排除标准选择出208例患者进行分析。记录每例患者的性别、身高、体重、输血情况、术前和术后的血常规、显性失血情况等资料,利用Gross方程和Nadler提供的方程等,计算出每个PFNA内固定术后患者的总失血量、显性失血量和隐性失血量,并分析隐性失血量与患侧、性别、年龄、BMI (Body Mass Index)、骨折类型、手术用时、糖尿病、高血压病、受伤至手术的时间、是否使用注射用灯盏花素等因素的相关性。结果：本研究中患者从受伤至手术期间的平均时间为(5.76±2.830)天,手术用时平均为(69.76±21.67)min,术后出现HCT最低的时间平均是术后(3.21±1.04)天,实际失血总量(773.16±289.65)mL,隐性失血量(658.39±259.15)mL。隐性失血量占实际失血总量的84.7%,且与骨折类型、性别、糖尿病、手术用时、高血压病等因素显著性相关(P0.05),有显著性影响的变量从大到小依次为骨折类型,性别,糖尿病,手术用时,高血压病。结论：股骨转子间骨折患者行PFNA内固定术后存在较多的隐性失血,且与骨折类型、性别、糖尿病、手术用时、原发性高血压等因素有显著性相关性,临床工作中,我们必须意识到隐性失血量的存在,及时复查血容量,必要时给予输血处理,特别是出现多个与隐性失血有显著相关的危险因素时,从而减少并发症,提高临床疗效。
[Abstract]:Objective: through the use of proximal femoral nail anti rotation (proximal femoral nail anti-rotation, PFNA) of various blood loss in patients of femur for the treatment of the fracture, to verify the existence of hidden blood loss after surgery, and explore the relationship between hidden blood loss and various influence factors, so as to better guide the clinical method. Description: a prospective analysis of hospitalized in the Department of orthopedics of Guangdong Province Traditional Chinese Medical Hospital ward during 2013 01 to 2015 02 months, in strict accordance with the relevant diagnostic criteria, inclusion criteria and exclusion criteria selected 208 cases of patients were analyzed. Records of each patient's gender, height, weight, blood transfusion, preoperative and postoperative blood routine, blood explicit data, using the Gross equation and the Nadler equation, calculate each PFNA after internal fixation in patients with total blood volume, dominant blood loss and hidden blood loss The analysis, and the hidden blood loss and the affected side, gender, age, BMI (Body Mass Index), the type of fracture, surgery, diabetes, hypertension, injury to operation time, whether the use of injectable breviscapine related factors. Results: the average time of patients during the study from injury to surgery for (5.76 + 2.830) days, the average operation time was (69.76 + 21.67) min, postoperative HCT the lowest average postoperative time (3.21 + 1.04) days, the actual total blood loss (773.16 + 289.65) mL, occult blood loss (658.39 + 259.15) mL. occult blood loss accounted for the total blood loss 84.7%, and fracture type, sex, diabetes, surgery, hypertension and other factors significantly related (P0.05), has a significant impact of the variables are fracture type, from large to small gender, diabetes, surgery, hypertension. Conclusion: patients who underwent PFNA internal fixation for intertrochanteric fracture Are there hidden blood loss after surgery, and fracture type, sex, diabetes, surgery, there was significant correlation between the factors of primary hypertension, clinical work, we must be aware of the existence of hidden blood loss, timely review of blood volume, blood transfusion for treatment when necessary, especially the appearance of more than one and there are significant risk factors of hidden blood loss related, so as to reduce the complications and improve the curative effect.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】