后路初次全髋关节置换术后隐性失血的影响因素：一项回顾性研究。
Influencing factors of hidden blood loss after primary total hip arthroplasty through the posterior approach: a retrospective study.
机构信息
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
出版信息
BMC Musculoskelet Disord. 2023 Jul 17;24(1):582. doi: 10.1186/s12891-023-06716-z.
BACKGROUND
Total hip arthroplasty (THA) is an excellent treatment for the end-stage hip disease, and perioperative blood management strategies have been effectively applied to this procedure. However, many patients still experience anemia after the operation, which is usually overlooked by orthopedic surgeons due to the hidden blood loss (HBL) in the perioperative period. Therefore, the objective of this study was to evaluate HBL in patients undergoing primary THA using the posterior approach and to explore its influencing factors.
METHODS
A retrospective analysis of 707 patients who underwent primary THA through the posterior approach was conducted in our hospital from January 2020 to January 2022. By applying Gross's and Nadler's formula, the HBL was calculated. Six quantitative variables (age, body mass index, surgical duration, albumin loss, preoperative hemoglobin, and hemoglobin loss) as well as four qualitative variables (gender, American Society of Anesthesiologists class, major preoperative diagnosis, and hypertension) of patients were analyzed using multivariate linear regression.
RESULTS
The HBL was recorded at 700.39 ± 368.59 mL. As a result of multivariate linear regression analysis, it was determined that body mass index, surgical duration, and hemoglobin loss were all significant risk factors for HBL, whereas preoperative hemoglobin was considered a protective factor. It has been demonstrated that HBL is not significantly correlated with age, albumin loss, gender, ASA class, or major preoperative diagnosis, but it also did not differ from HBL by hypertension.
CONCLUSIONS
Hidden blood Loss (HBL) in patients after primary total hip arthroplasty (THA) using the posterior approach is large and significant. When optimizing the perioperative management of THA, orthopedic surgeons should keep in mind HBL and its influencing factors, especially for patients with high body mass indexes, long surgical durations, and low preoperative hemoglobin levels.
TRIAL REGISTRATION
This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100053888) in 02/12/2021, http://www.chictr.org.cn .
背景
全髋关节置换术（THA）是治疗髋关节终末期疾病的一种极佳方法，围手术期血液管理策略已被有效地应用于该手术。然而，许多患者在手术后仍会出现贫血，由于围手术期存在隐性失血（HBL），这通常被骨科医生所忽视。因此，本研究旨在评估后路初次 THA 患者的 HBL，并探讨其影响因素。
方法
对 2020 年 1 月至 2022 年 1 月在我院行后路初次 THA 的 707 例患者进行回顾性分析。采用 Gross 公式和 Nadler 公式计算 HBL。对患者的 6 个定量变量（年龄、体重指数、手术时间、白蛋白丢失量、术前血红蛋白和血红蛋白丢失量）和 4 个定性变量（性别、美国麻醉医师协会分级、主要术前诊断和高血压）进行多元线性回归分析。
结果
HBL 记录为 700.39±368.59mL。多元线性回归分析结果显示，体重指数、手术时间和血红蛋白丢失量均为 HBL 的显著危险因素，而术前血红蛋白为保护因素。HBL 与年龄、白蛋白丢失量、性别、ASA 分级或主要术前诊断无显著相关性，但与高血压引起的 HBL 也无差异。
结论
后路初次全髋关节置换术后患者的隐性失血（HBL）较大且显著。当优化 THA 的围手术期管理时，骨科医生应牢记 HBL 及其影响因素，特别是对于体重指数较高、手术时间较长和术前血红蛋白水平较低的患者。
试验注册
本研究于 2021 年 02 月 12 日在中国临床试验注册中心（ChiCTR2100053888）注册，网址为：http://www.chictr.org.cn 。
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