Šarić Jadrijev Ana, Bego Ana, Lojpur Borna, Poljak Dino, Žaja Marija, Matas Jakov, Pivalica Božen, Stojanović Stipić Sanda, Čapkun Vesna, Vukojević Katarina, Glavina Durdov Merica, Bratanić Andre
Department of Anaesthesiology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia.
Institute of Emergency Medicine in Split-Dalmatia County, Spinčićeva 1, 21000 Split, Croatia.
Biomedicines. 2024 Sep 8;12(9):2041. doi: 10.3390/biomedicines12092041.
In hip fracture patients, who are mostly elderly, preexisting anemia can be worsened when combined with trauma and surgery. To this date, there is no unequivocal approach about transfusion thresholds. We analyzed hemoglobin (Hb) and hematocrit (Hct) levels at three time points in surgical patients with proximal femoral fractures (PFF) to see which levels were triggers for transfusions and whether transfusions were related to mortality after hospital discharge. A total of 956 patients were operated on from 1 January 2021 to 31 December 2022 at the University Hospital of Split and included in the study. There were more women (74%); 47% patients had admission Hb < 120 g/L. Transfusion was given preoperatively to 88, intraoperatively to 74 and postoperatively to 309 patients. Transfusion thresholds were as follows: Hb 84 g/L preoperatively, 99 intraoperatively and 83 postoperatively. After hospital discharge, 10.79% of patients died within the 1st month and 23% within 6 months. In the group of non-survivors, 60% of patients had admission Hb ≤ 117 g/L and the proportion of patients transfused preoperatively was two times higher. Preoperative transfusion thresholds could be set to higher levels for patients with surgically treated PFF. However, that could increase mortality even more. Further investigation is necessary.
在髋部骨折患者中，这类患者大多为老年人，先前存在的贫血在合并创伤和手术后可能会加重。迄今为止，关于输血阈值尚无明确的方法。我们分析了股骨近端骨折（PFF）手术患者在三个时间点的血红蛋白（Hb）和血细胞比容（Hct）水平，以确定哪些水平是输血的触发因素，以及输血是否与出院后的死亡率相关。2021年1月1日至2022年12月31日期间，共有956例患者在斯普利特大学医院接受手术并纳入研究。女性患者更多（74%）；47%的患者入院时Hb<120 g/L。术前88例患者接受输血，术中74例，术后309例。输血阈值如下：术前Hb 84 g/L，术中99 g/L，术后83 g/L。出院后，10.79%的患者在第1个月内死亡，23%在6个月内死亡。在非存活患者组中，60%的患者入院时Hb≤117 g/L，术前输血患者的比例高出两倍。对于接受手术治疗的PFF患者，术前输血阈值可以设定为更高水平。然而，这可能会进一步增加死亡率。有必要进行进一步调查。
