Cuenca J, García Erce J A, Martínez A A, Solano V M, Herrera A
Servicio de Cirugía Ortopédica y Traumatología, emoterapia. Hospital Universitario Miguel Servet, Zaragoza.
Rev Esp Anestesiol Reanim. 2004 Nov;51(9):515-22.
To determine the effect of risk factors for allogenic blood transfusion in surgery for trochanteric hip fractures.
A retrospective study of all the trochanteric hip fracture patients older than 65 years who underwent surgery to repair trochanteric hip fracture related to osteoporosis in 2000 and 2001 in a regional hospital. Data recorded were age; gender; type of fracture (international AO classification); level of anesthetic risk (ASA classification); hemoglobin concentration and hematocrit upon admission, on the day of surgery and 2 days later; time elapsing between admission and surgery; blood transfusion and blood product use.
One hundred two patients (29 men and 73 women) with trochanteric hip fractures were studied. Mean (+/- SD) patient age was 82.9 +/- 8.8 years (range, 65-99 years). Upon admission, mean hemoglobin was 123 +/- 18.1 g/L (range, 56-154 g/L), hematocrit was 37% +/- 5% (range, 10%-40%). Time elapsing until surgery was 3.5 +/- 1.6 days (range, 0-8 days). Admission hemoglobin concentration was lower in patients who required transfusion (116 g/L) than in patients who did not (133 g/L) (P < 0.001). Logistical regression analysis identified only AO classification of fracture type (P < 0.05) and admission hemoglobin concentration (P < 0.001) as independent risk factors for transfusion.
The hemoglobin level at admission and the trochanteric fracture type bear a relation to transfusion needs. These results suggest that in elderly patients we should improve hemoglobin levels and initiate blood salvage measures in order to reduce the need for allogenic blood transfusion, with its inherent risks.
确定转子间髋部骨折手术中同种异体输血风险因素的影响。
对2000年和2001年在一家地区医院接受手术修复与骨质疏松相关的转子间髋部骨折的所有65岁以上转子间髋部骨折患者进行回顾性研究。记录的数据包括年龄、性别、骨折类型（国际AO分类）、麻醉风险级别（ASA分类）、入院时、手术当天及术后2天的血红蛋白浓度和血细胞比容、入院至手术的时间间隔、输血及血液制品使用情况。
研究了102例转子间髋部骨折患者（29例男性和73例女性）。患者平均年龄为82.9±8.8岁（范围65 - 99岁）。入院时，平均血红蛋白为123±18.1 g/L（范围56 - 154 g/L），血细胞比容为37%±5%（范围10% - 40%）。至手术的时间间隔为3.5±1.6天（范围0 - 8天）。需要输血的患者入院时血红蛋白浓度（116 g/L）低于不需要输血的患者（133 g/L）（P < 0.001）。逻辑回归分析仅确定骨折类型的AO分类（P < 0.05）和入院时血红蛋白浓度（P < 0.001）为输血的独立风险因素。
入院时血红蛋白水平和转子间骨折类型与输血需求有关。这些结果表明，在老年患者中，我们应提高血红蛋白水平并启动血液回收措施，以减少对同种异体输血及其固有风险的需求。
