Chu C, Su H M, Han Z, Liu Y L, Sha Q L, Xu S, Tan R Y, He Y F
Department of Spinal Surgery, Heze Municipal Hospital, Heze 274000, China.
Department of Spinal Surgery, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Yi Xue Za Zhi. 2021 Mar 23;101(11):792-797. doi: 10.3760/cma.j.cn112137-20201009-02791.
To compare the intraoperative blood loss, postoperative drainage and hidden blood loss (HBL) in lumbar posterior lumbar interbody fusion (PLIF) in patients with and without rheumatoid arthritis (RA), and analyze the relevant factors of HBL in RA patients. Fifty patients with RA (RA group) and 73 patients without RA (NRA group) treated in the Heze Municipal Hospital from January 2014 to April 2019 were enrolled in this study. The basic information, RA information, operation and related blood loss indicators in the two groups were compared. The intraoperative blood loss, postoperative drainage and HBL were the main results. The secondary results were operation time, preoperative and postoperative hematocrit (Hct) and hemoglobin (Hb) and their variation values, cases of anemia before and after surgery, number of new anemia after surgery, autologous blood and allogeneic blood transfusion, etc. The correlation factors of HBL in RA group were analyzed by multi-linear regression model. There were 9 males and 41 females with a mean age of (62±7) years in RA group; and 11 males and 62 females with a mean age of (64±9) years in NRA group. The course of disease in RA group was (14.4±11.2) years, the most common anti-rheumatism drug (DMARDs) were single-drug and combined oral. There was no significant differences between the two groups in the number of vertebral bow screws and intervertebral fusion device. The incidence of surgical complications was comparable between the two groups. Differences between the two groups in total blood loss (TBL), intraoperative blood loss, and postoperative drainage were not statistically significant ((693±315) ml vs (630±365) ml, (454±373) ml vs (414±375) ml and (653±376) ml vs (675±400) ml, =1.072, 0.388, -0.189, all >0.05), while the HBL and the percentage of HBL in TBL were lower in the NRA group (=6.157, 2.965, both <0.05). According to the layered analysis of the number of surgical segments, the proportion of HBL and the HBL percentage of TBL in the NRA group for the long section (≥3 segments) surgery were better than those in the RA group. The Hct changing value was larger in the RA group than that in the NRA group (=0.031). However, the difference of Hb reduction between the two groups was not statistically significant (>0.05). There was no significant difference in anemia and exacerbation of anemia after surgery, allogeneic blood transfusion and the operation duration between the two groups (all >0.05). A multi-linear regression analysis of HBL showed that higher RA's Steinbrocker grading, did not take DMARDS, Hb changes and infusion of allogeneic blood were independently correlated to HBL (β=0.363, -0.272, 0.210, 1.204, all <0.05). There is no difference in TBL, intraoperative blood loss, postoperative drainage and operation duration between the RA and NRA group, while HBL and the proportion of HBL in the TBL are higher in the RA group. The RA group has higher Steinbrocker rating, no DMRDs and more Hb changes.
比较类风湿关节炎（RA）患者和非RA患者行腰椎后路椎间融合术（PLIF）时的术中失血量、术后引流量及隐性失血（HBL），并分析RA患者HBL的相关因素。选取2014年1月至2019年4月在菏泽市立医院治疗的50例RA患者（RA组）和73例非RA患者（NRA组）纳入本研究。比较两组患者的基本信息、RA信息、手术及相关失血指标。主要结果为术中失血量、术后引流量及HBL。次要结果为手术时间、术前及术后血细胞比容（Hct）和血红蛋白（Hb）及其变化值、手术前后贫血病例数、术后新发贫血病例数、自体血及异体血输注等。采用多线性回归模型分析RA组HBL的相关因素。RA组男9例，女41例，平均年龄（62±7）岁；NRA组男11例，女62例，平均年龄（64±9）岁。RA组病程为（14.4±11.2）年，最常用的抗风湿药物（DMARDs）为单药及联合口服。两组椎弓根螺钉及椎间融合器数量无显著差异。两组手术并发症发生率相当。两组患者总失血量（TBL）、术中失血量及术后引流量差异无统计学意义（（693±315）ml对（630±365）ml，（454±373）ml对（414±375）ml，（653±376）ml对（675±400）ml，F =1.072、0.388、-0.189，均>0.05），而NRA组HBL及HBL占TBL的百分比更低（F =6.157、2.965，均<0.05）。根据手术节段数分层分析，NRA组长节段（≥3节段）手术的HBL比例及HBL占TBL的百分比均优于RA组。RA组Hct变化值大于NRA组（F =0.031）。然而，两组间Hb降低差异无统计学意义（P>0.05）。两组患者术后贫血及贫血加重、异体血输注及手术时长差异均无统计学意义（均>0.05）。对HBL进行多线性回归分析显示，RA的Steinbrocker分级较高、未使用DMARDs、Hb变化及异体血输注与HBL独立相关（β=0.363、-0.272、0.210、1.204，均<0.05）。RA组和NRA组在TBL、术中失血量、术后引流量及手术时长方面无差异，但RA组HBL及HBL占TBL的比例更高。RA组Steinbrocker分级更高、未使用DMARDs且Hb变化更多。
