摘要
背景:老年股骨转子间骨折围手术期大量隐性失血的出现不仅增加围手术期风险和并发症,而且会影响术后的关节功能恢复。目前国内外尚未有关于营养状况与术前隐性失血的相关报道。目的:明确老年股骨转子间骨折患者入院时营养状况对术前隐性失血的影响。方法:纳入183例获得完整随访的新鲜初次股骨转子间骨折患者,入院时和术前均常规行血清实验室检查;根据微型营养评价法评分将患者分为营养正常组、潜在营养不良组和营养不良组,根据患者身高、体质量、入院时和术前红细胞压积,计算所有患者的术前血容量和隐性失血量,按照术前隐性失血量占术前血容量比例将所有患者分为低和高隐性失血量组。比较3个营养组间术前隐性失血量及其占术前血容量的比例和术前高隐性失血发生率是否有差异,分析术前高隐性失血与术前营养状况之间的关系。结果与结论:(1)所有患者经微型营养评价法评估得出营养正常者48例(26%),潜在营养不良者64例(35%),营养不良者71例(39%),各分组患者术前各合并症之间差异无显著性意义(P>0.05);(2)共38例患者发生高隐性失血,术前隐性失血量平均260.43 mL,术前隐性失血量占术前血容量的平均比例为6%;(3)营养不良和潜在营养不良患者术前隐性失血量及其占术前血容量比例和高隐性失血发生率均明显高于营养正常患者,各分组两两间比较,差异均有显著意义(P<0.05);(4)结果验证,老年股骨转子间骨折患者术前隐性失血量及其占术前血容量的比例和高隐性失血发生率均随着营养状况的恶化而逐渐升高;营养状况是术前隐性失血发生的重要影响因素,可作为老年股骨转子间骨折患者判断高隐性失血和预后的重要指标。
BACKGROUND： The emergence of a large number of hidden blood loss during perioperative period of intertrochanteric fracture in the elderly not only increases the risk of perioperative period and complications, but also affects the postoperative recovery of joint function. At present, there is no relevant report about nutritional status and the hidden blood loss before surgery in and outside China. OBJECTIVE： To identify the effect of nutritional status on preoperative hidden blood loss in elderly patients with intertrochanteric fracture.METHODS： 183 elderly patients with fresh and initial femoral intertrochanteric fracture were included. Laboratory serological examinations on admission and preoperation were completed. By mini nutritional assessment, patients were randomly divided into normal-nourishment group, malnourishment at risk group, and malnourishment group. The original blood volume and preoperative hidden blood loss were calculated depending on height, weight, hematocrit on admission and preoperation. According to the proportion of mean preoperative hidden blood loss on the original blood volume, patients were divided into low and high hidden blood loss groups. We compared preoperative hidden blood loss, and their proportion on the original blood volume and the preoperative incidence of high hidden blood loss, and analyzed the correlations between preoperative high hidden blood loss and preoperative nutritional status. RESULTS AND CONCLUSION：（1） The nutritional status of elderly intertrochanteric fracture patients measured by mini nutritional assessment score was that the number of patients was 48 cases（26%） in normal-nourishment group, 64 cases（35%） in the malnourishment at risk group, and 71 cases（39%） in the malnourishment group. There were no obvious differences in the preoperative complications between any two groups（P〈0.05）.（2） Thirty-eight cases affected high hidden blood loss. The mean preoperative hidden blood loss was 260.43 m L. The proportion of preoperative hidden blood loss to the original blood volume was 6%.（3） The preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss were significantly higher in the malnourishment at risk group and malnourishment group than in the normal-nourishment group. Paired comparison showed significant differences（P〈0.05）.（4） Results confirmed that preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss gradually increased with deterioration of nutritional status. The nutritional status is an important factor influencing the occurrence of preoperative hidden blood loss, and can be used as an important index for judging the high hidden blood loss and prognosis in elderly patients with intertrochanteric fracture.
出处
《中国组织工程研究》
CAS
北大核心
2016年第37期5489-5495,共7页
Chinese Journal of Tissue Engineering Research
基金
南京市科技计划项目(201303039)
南京军区科技创新项目(MS055)~~
