股骨粗隆间骨折围手术期隐性失血分析：骨密度是重要影响因素。
An analysis of perioperative hidden blood loss in femoral intertrochanteric fractures: bone density is an important influencing factor.
机构信息
Department of Orthopaedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, 226600, Jiangsu, China.
Department of Orthopaedic Surgery, Affiliated Hospital of Nantong University, Xisi Road 20, Nantong, 226001, Jiangsu, China.
出版信息
BMC Musculoskelet Disord. 2021 Jan 4;22(1):6. doi: 10.1186/s12891-020-03922-x.
BACKGROUND
To explore the influencing factors of perioperative hidden blood loss in intertrochanteric fractures.
METHOD
We undertook a retrospective analysis from January 2016 to October 2019. Clinical data of 118 patients with intertrochanteric fractures were included. Hidden blood loss was calculated from the haematocrit changes before and after surgery using the Gross equation based on height, weight, and haematocrit (HCT) changes before and after surgery. Patients' gender, age, presence of underlying diseases, fracture types, anaesthesia methods, time from injury to surgery, administration of antiplatelet drugs within 6 months before surgery, use of anticoagulant drugs after surgery, and bone density were statistically analysed. Factors having an effect on hidden blood loss were screened out. Then, hidden blood loss was used as the dependent variable, and each influencing factor was used in turn as the independent variable. Multivariate linear regression analysis was employed to analyse the related risk factors that affect hidden blood loss during the perioperative period of patients with intertrochanteric fractures.
RESULT
The apparent blood loss during the operation was 203.81 ±105. 51 ml, and the hidden blood loss was 517.55±191.47 ml. There were significant differences in the hidden blood loss of patients with different fracture types (stable vs unstable), anaesthesia methods (general anaesthesia vs intraspinal anaesthesia), antiplatelet or postoperative anticoagulant drugs, and bone densities (P< 0.05). 05). Multiple linear regression analysis showed that internal fixation, age, fracture type, anaesthesia method, anticoagulant application, and bone density were related risk factors that affected hidden blood loss during the surgical treatment of intertrochanteric fractures.
CONCLUSION
Hidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures, and the risk factors for hidden blood loss include internal fixation, fracture type (e.g., unstable), anaesthesia (e.g., intraspinal), and use of anticoagulant drugs. Specifically, we found that low bone density was a risk factor for hidden blood loss. It is not reliable to use apparent blood loss as the basis for fluid replacement and transfusion. We must fully consider the existence of hidden blood loss and intervene as soon as possible to prevent complications.
LEVEL OF EVIDENCE
III.
背景
探讨影响股骨转子间骨折围手术期隐性失血的因素。
方法
回顾性分析 2016 年 1 月至 2019 年 10 月收治的 118 例股骨转子间骨折患者的临床资料。根据术前、术后红细胞压积（HCT）的变化，应用 Gross 方程计算隐性失血量。统计患者的性别、年龄、基础疾病、骨折类型、麻醉方式、受伤至手术时间、术前 6 个月内应用抗血小板药物、术后应用抗凝药物、骨密度等，分析影响隐性失血的因素。筛选出影响隐性失血的因素后，以隐性失血量为因变量，依次以各影响因素为自变量，采用多元线性回归分析股骨转子间骨折患者围手术期隐性失血的相关危险因素。
结果
手术显性失血量为（203.81±105.51）ml，隐性失血量为（517.55±191.47）ml。不同骨折类型（稳定型与不稳定型）、麻醉方式（全身麻醉与椎管内麻醉）、抗血小板或术后抗凝药物应用、骨密度患者隐性失血量比较，差异均有统计学意义（P<0.05）。多元线性回归分析显示，内固定方式、年龄、骨折类型、麻醉方式、抗凝药物应用、骨密度是影响股骨转子间骨折手术治疗隐性失血的相关危险因素。
结论
隐性失血是股骨转子间骨折围手术期失血的主要原因，隐性失血的危险因素包括内固定方式、骨折类型（不稳定型）、麻醉方式（椎管内麻醉）和抗凝药物的应用。具体而言，我们发现低骨密度是隐性失血的一个危险因素。不能仅以显性失血量作为补液和输血的依据，必须充分考虑隐性失血的存在并尽早干预，以预防并发症。
证据水平
III 级。
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