摘要
目的探讨股骨颈骨折全髋关节置换术后隐匿性失血(HBL)的危险因素。方法回顾性分析2017年6月—2019年6月南通大学附属丹阳医院骨科收治的股骨颈骨折150例患者资料,其中男性98例,女性52例;年龄72~88岁,平均82.8岁。致伤机制:高处坠落伤6例,道路交通伤5例,摔跌伤122例,打架致伤17例。全髋置换术前和术后第3天抽血测量Hb和Hct水平。根据Gross s公式分别计算总失血量(TBL)和HBL。通过多元线性回归进一步分析HBL的危险因素。结果多元线性回归分析显示美国麻醉师协会(ASA)分级(B=62.169,95%CI=15.616~108.722;P=0.009)、围手术期胃肠道出血/溃疡(B=55.589,95%CI=38.095~273.083;P=0.010)和输血(B=192.118,95%CI=135.578~248.659;P<0.001)是HBL的危险因素。与女性相比,男性患者HBL增高的风险明显增加(B=87.414,95%CI=28.547~146.280;P=0.004),与硬膜外相比,全身麻醉的患者HBL升高的风险明显增加(B=68.920,95%CI=11.707~126.134;P=0.018)。结论男性、ASA分级较高、围手术期胃肠道出血/溃疡、全身麻醉或接受输血治疗均是股骨颈骨折患者行全髋关节置换术后HBL增高的危险因素。
Objective To explore the risk factors of hidden blood loss after total hip arthroplasty for femoral neck fractures.Methods A retrospective analysis was conducted in the data of 150 patients with femoral neck fractures admitted to the Department of Orthopedics,Danyang Hospital Affiliated to Nantong University from Jun.2017 to Jun.2019.There were 98 males and 52 females;aged 72-88 years,with an average of 82.8 years.Injury mechanism included:6 cases of high falling injuries,5 cases of road traffic injuries,122 cases of falls and 17 cases of fighting injuries.Hb and Hct levels were measured before and on the 3rd day after total hip replacement.Total blood loss(TBL)and hidden blood loss(HBL)were calculated according to the Gross s formula.The risk factors of HBL were further analyzed by multiple linear regression.Results Multiple linear regression analysis showed that the ASA grade(β=62.169,95%CI=15.616-108.722;P=0.009),perioperative gastrointestinal bleeding/ulcer(β=55.589,95%CI=38.095-273.083;P=0.010)and blood transfusion(β=192.118,95%CI=135.578-248.659;P<0.001)were risk factors for HBL.Compared with women,the risk of increased HBL in male patients was significantly increased(β=87.414,95%CI=28.547-146.280;P=0.004).Compared with epidural patients,the risk of increased HBL in patients under general anesthesia was significantly increased(β=68.920,95%CI=11.707-126.134;P=0.018).Conclusion Male gender,high ASA grade,perioperative gastrointestinal bleeding/ulcer,general anesthesia,and blood transfusion are all risk factors for increased HBL after total hip replacement in patients with femoral neck fracture.
作者
蒋波逸
周立建
成欣
高炳俊
JIANG Bo-yi;ZHOU Li-jian;CHENG Xin;GAO Bing-jun(Department of Orthopaedics,Danyang Hospital,Nantong University,Danyang,Jiangsu 212300,China)
出处
《创伤外科杂志》
2020年第12期932-935,共4页
Journal of Traumatic Surgery
基金
江苏省卫生计生委2017年度面上科研课题(H201742)。
