老年股骨粗隆间骨折髓内固定术后隐性失血的相关因素分析

发布时间：2018-04-14 09:21

  本文选题：老年 + 股骨粗隆间骨折　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:分析老年股骨粗隆间骨折闭合复位髓钉内固定术后影响患者隐性失血的相关因素,于围手术期评估相关因素以预防因隐性失血过多而导致贫血所引起的不良后果,从而保障临床治疗效果。方法:回顾性研究2014年9月至2016年3月接受闭合复位髓钉内固定治疗的86例老年股骨粗隆间骨折患者资料,根据Cross方程计算全部患者术后隐性失血量(postoperative hidden blood loss,PHBL)的绝对值及其所占总血容量(patient blood volume,PBV)的百分比(PHBL%),并分别以患者术后隐性失血量绝对值及其所占总血容量百分比为因变量,均以性别、身体质量指数(body mass index,BMI)、术前是否抗凝、手术持续时间及术后是否输血为自变量进行单因素分析及多元线性回归分析。结果:1、术后隐性失血量绝对值组单因素分析显示:患者术前是否抗凝及术后是否输血的各组间隐性失血量绝对值的差异均有统计学意义(P0.05),多元线性回归分析显示:术前是否抗凝及术后是否输血与术后隐性失血量绝对值呈线性回归关系;2、术后隐性失血量占总血容量百分比(PHBL%)组单因素分析显示:患者性别、BMI及术前是否抗凝的各组间的PHBL%差异均有统计学意义(P0.05),多元线性回归分析显示:性别、BMI及术前是否抗凝与术后的PHBL%呈线性回归关系;3、男性组与女性组平均隐性失血量绝对值及PHBL%分别为(647.52±63.23)ml、(652.72±70.31)及14.2%±3.6%、18.6%±5.2%;(BMI≥24Kg/m2)组与(BMI24Kg/m2)组平均隐性失血量及PHBL%分别为(654.28±68.83)ml、(644.62±73.23)ml及13.1%±4.7%、17.8%±6.3%;术前抗凝组与未抗凝组平均隐性失血量及PHBL%分别为(682.83±66.23)ml、(639.56±72.52)ml及19.2%±3.3%、13.9%±4.1%;手术持续时间≥80min组与手术持续时间80min组平均隐性失血量及PHBL%分别为(655.37±66.87)ml、(648.58±78.36)及14.0%±4.3%、13.8%±7.1%;术后输血组与未输血组平均隐性失血量及其百分比分别为(627.76±53.64)ml、(660.62±70.16)ml及14.7%±6.0%、14.8%±3.6%。结论:隐性失血是导致老年股骨粗隆间骨折髓内固定术后失血严重的主要原因,隐性失血量的绝对值与术前是否抗凝及术后是否输血相关,隐性失血量绝对值所占总血容量的百分比与性别、BMI及术前是否抗凝相关。
[Abstract]:Objective: to analyze the related factors influencing recessive blood loss after closed reduction and internal fixation of femoral intertrochanteric fracture in elderly patients, and to evaluate the related factors during perioperative period in order to prevent the adverse consequences of anemia caused by recessive hemorrhage.So as to ensure the clinical effect of treatment.Methods: the data of 86 elderly patients with intertrochanteric fracture of femur who were treated with closed reduction and intramedullary nail fixation from September 2014 to March 2016 were retrospectively studied.According to the Cross equation, the absolute value of postoperative hidden blood loss and the percentage of patient blood volume were calculated by Cross equation, and the absolute value of recessive blood loss and its percentage of total blood volume were taken as dependent variables, respectively.Sex, body mass index (BMI), body mass index (BMI), preoperative anticoagulation, duration of operation and blood transfusion were used as independent variables for univariate analysis and multivariate linear regression analysis.Results one factor analysis showed that there were significant differences in the absolute value of recessive blood loss between the two groups (P 0.05). The multiple linear regression analysis showed that there was no significant difference in the absolute value of recessive blood loss between the two groups before operation and whether blood transfusion was given after operation. Multivariate linear regression analysis showed that there were significant differences in the absolute value of recessive blood loss between the two groups.: there was a linear regression relationship between preoperative anticoagulant and postoperative blood transfusion and the absolute value of recessive blood loss after operation. The single factor analysis showed that the patient's gender BMI and preoperative anticoagulation were higher than that of PHBL group.Multivariate linear regression analysis showed that there was a linear regression relationship between PHBL% and sex BMI, and the mean recessive blood loss and PHBL% score in male and female groups were significantly higher than those in male and female groups.鍒�涓�(647.52卤63.23)ml,(652.72卤70.31)鍙，

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