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股骨转子间骨折患者围手术期输血的影响因素分析

Analysis of influencing factors of blood transfusion in patients with intertrochanteric fracture during perioperative period

  • 摘要:
    目的 探讨股骨转子间骨折患者围手术期输血的影响因素。
    方法 收集2013年1月至2018年1月因股骨转子间骨折于复旦大学附属金山医院手术281例患者的病例资料,包括性别,年龄,骨折Evans-Jensen分型,既往是否有高血压病史、冠心病史、糖尿病史及脑梗死病史,术前白蛋白、血红蛋白、血小板、活化部分凝血活酶时间,术前等候天数,手术方式,美国麻醉医师协会(ASA)麻醉分级以及是否输血。按是否输血分为输血组(127例)与非输血组(154例)。采用t检验、秩和检验、χ2检验、logistic回归进行统计学处理。
    结果 围手术期的输血率为45.2%(127/281)。输血组与未输血组相比,性别、骨折分型、糖尿病病史、脑梗死病史、手术方式、麻醉分级、年龄、术前白蛋白水平、术前血红蛋白水平、术前血小板水平及术前等候天数差异均有统计学意义(P < 0.05)。多因素logistic回归分析显示,输血的影响因素有骨折分型为4型或5型、术前血红蛋白 < 90 g/L、有脑梗死病史、手术方式为人工股骨头置换或行切开复位股骨近端抗旋髓内钉固定术。
    结论 股骨转子间骨折分型为4型或5型、术前血红蛋白 < 90 g/L、有脑梗死病史、手术方式为人工股骨头置换或行切开复位股骨近端抗旋髓内钉固定术对股骨转子间骨折患者围手术期输血有影响。

     

    Abstract:
    Objective To explore the influencing factors of blood transfusion in patients with intertrochanteric fracture during perioperative period.
    Methods Data of 281 cases with intertrochanteric fractures treated in Jinshan Hospital, Fudan University from January 2013 to January 2018 were collected, include gender, age, classification of fracture, hypertension, coronary heart disease, diabetes mellitus, cerebral infarction, preoperative levels of albumin, hemoglobin, platelet, and activated partial thromboplastin time (APTT), preoperative waiting days, surgical method, American Society of Anesthesiologists (ASA) classification and blood transfusion. The t test, rank sum test, χ2 test and logistic regression were used for statistical analysis.
    Results The transfusion rate was 45.20% (127/281). There were significant differences in gender, age, classification of fracture, diabetes mellitus, cerebral infarction, surgical method, ASA classification, preoperative waiting days and preoperative levels of albumin, hemoglobin, and platelet between the transfusion group and the non-transfusion group (P < 0.05). Multivariate logistic regression analysis showed that the influencing factors of blood transfusion were fracture type 4 or 5, preoperative hemoglobin < 90 g/L, history of cerebral infarction, and surgical method of artificial femoral head replacement or open reduction with proximal femoral nail antirotation.
    Conclusions The influencing factors of perioperative blood transfusion of patients with intertrochanteric fracture include the classification of type 4 or type 5, preoperative hemoglobin < 90 g/L, history of cerebral infarction, artificial femoral head replacement or open reduction and proximal femoral nail fixation.

     

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