Lei Fei, Li Zhongyang, He Wen, Tian Xinggui, Zheng Lipeng, Kang Jianping, Feng Daxiong
Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou.
Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu.
Medicine (Baltimore). 2020 May;99(19):e20103. doi: 10.1097/MD.0000000000020103.
Hidden blood loss (HBL) plays an important role in perioperative rehabilitation of patients underwent posterior lumbar fusion surgery. This study was to calculate the volume of HBL and evaluate the risk factors among patients after posterior lumbar fusion surgery.A retrospective analysis was made on the clinical data of 143 patients underwent posterior lumbar fusion surgery from March 2017 to December 2017. Recording preoperative and postoperative hematocrit to calculate HBL according to Gross formula and analyzing its related factors including age, sex, height, weight, body mass index (BMI), surgery levels, surgical time, surgery types, duration of symptoms, disorder type, specific gravity of urine (SGU), plasma albumin (ALB), glomerular filtration rate (GFR), glucose (GLU), drainage volume, hypertension. Risk factors were further analyzed by multivariate linear regression analysis and t test.Eighty-six males and 57 females, mean age 52.7 ± 11.4 years, mean height 162 ± 7.0, mean weight 61.5 ± 9.4, were included in this study. The HBL was 449 ± 191 mL, with a percentage of 44.2% ± 16.6% in the total perioperative blood loss. Multivariate linear regression analysis revealed that patients with higher BMI (P = .026), PLIF procedures (P = .040), and more surgical time (P = .018) had a greater amount of HBL. Whereas age (P = 0.713), sex (P = .276), surgery levels (P = .921), duration of symptoms (P = .801), disorder type (P = .511), SGU (P = .183), ALB (P = .478), GFR (P = .139), GLU (P = .423), hypertension (P = .337) were not statistically significant differences with HBL.HBL is a large proportion of total blood loss in patients after posterior lumbar fusion surgery. BMI >24 kg/m, PLIF procedures, and more surgical time are risk factors of HBL. Whereas age, sex, surgery levels, duration of symptoms, disorder type, SGU, ALB, GFR, GLU, hypertension were not associated with HBL.
隐性失血（HBL）在接受后路腰椎融合手术患者的围手术期康复中起着重要作用。本研究旨在计算HBL的量，并评估后路腰椎融合手术后患者的危险因素。
对2017年3月至2017年12月期间接受后路腰椎融合手术的143例患者的临床资料进行回顾性分析。记录术前和术后血细胞比容，根据Gross公式计算HBL，并分析其相关因素，包括年龄、性别、身高、体重、体重指数（BMI）、手术节段、手术时间、手术类型、症状持续时间、疾病类型、尿比重（SGU）、血浆白蛋白（ALB）、肾小球滤过率（GFR）、血糖（GLU）、引流量、高血压。通过多元线性回归分析和t检验进一步分析危险因素。
本研究纳入86例男性和57例女性，平均年龄52.7±11.4岁，平均身高162±7.0，平均体重61.5±9.4。HBL为449±191mL，占围手术期总失血量的44.2%±16.6%。多元线性回归分析显示，BMI较高（P = 0.026）、采用PLIF手术（P = 0.040）和手术时间较长（P = 0.018）的患者HBL量较大。而年龄（P = 0.713）、性别（P = 0.276）、手术节段（P = 0.921）、症状持续时间（P = 0.801）、疾病类型（P = 0.511）、SGU（P = 0.183）、ALB（P = 0.478）、GFR（P = 0.139）、GLU（P = 0.423）、高血压（P = 0.337）与HBL无统计学显著差异。
HBL在后路腰椎融合手术后患者的总失血量中占很大比例。BMI>24kg/m、PLIF手术和手术时间较长是HBL的危险因素。而年龄、性别、手术节段、症状持续时间、疾病类型、SGU、ALB、GFR、GLU、高血压与HBL无关。
