老年患者半髋关节置换围手术期隐性失血与功能锻炼的相关性研究

摘要

目的 探讨功能锻炼在预防老年髋部骨折患者半髋关节置换围手术期隐性失血中的应用.方法 回顾性分析2010年1月—2015年8月131例因单侧股骨颈骨折于南京中医药大学附属八一医院行初次半髋关节置换术的老年患者(年龄70~90岁,平均81.8岁),根据围手术期功能锻炼强度分为少量功能锻炼组(59例)和正常功能锻炼组(72例).根据患者身高、体重、术中出血量、术后引流和渗出量、手术前后红细胞压积和输血量,计算所有患者的总失血量及其占原血容量的比例、隐性失血量及其占总失血量的比例,按照平均隐性失血量占总失血量的比例分为低和高隐性失血量患者,分析功能锻炼与隐性失血量、高隐性失血发生率之间的关系.结果 所有患者总失血量平均为(964.05 ±284.92)mL,占原血容量的23.23%;隐性失血总量平均为417.86mL,占总失血量的43.34%.有52例患者发生高隐性失血,其中少量功能锻炼组33例,正常功能锻炼组19例,差异有统计学意义(P<0.05).总失血量及其占原血容量比例、隐性失血量及其占总失血量比例、高隐性失血发生率均随着功能锻炼强度的增加而逐渐降低(P<0.05);显性失血量随着功能锻炼强度的增加而降低,但差异无统计学意义(P>0.05).结论 老年患者关节置换术后早期正常强度的功能锻炼能够有效预防并减少围手术期总失血量和高隐性失血发生率.%Objective To identify the correlations between perioperative hidden blood loss(HBL)and function exercises in elderly patients with hemi -arthroplasty.Methods Totally 131 elderly patients with hip frac-tures aging from 70 to 90 years(average age of 81.8 years)were treated with hemi-arthroplasty from Jan.2010 to Aug.2015.According to the intensity of function exercises,patients were divided into little function exercises group (n=59)and normal function exercises group(n=72).The total blood loss,HBL and their proportion to the origi-nal blood volume and total blood loss were calculated depending on height,weight,intra-operative blood loss,post-operative drainage,pre-and post-operative Hct,and blood transfusion volume.According to the proportion of mean HBL on total blood loss,patients were divided into low HBL group and high HBL group.Then,the correlations be-tween HBL and function exercises were analyzed.Results The total blood loss was(964.05 ±284.92)mL,ac-counting for 23.23%of the total blood loss; the mean HBL was 417.86 mL,accounting for 43.34% of the total blood loss.Fifty-two cases were found to have high HBL,including 33 cases in little function exercises group,and 19 cases in normal function exercises group,which had significant differences between the two groups(P<0.05).The total blood loss and their proportion to the original blood volume,and the HBL and their proportion to the total blood loss were gradually decreased by the increased intensity of function exercises.The volume of the dominant blood loss was decreased by the increased intensity of function exercises but there was no difference between the two groups(P>0.05).Conclusion Normal function exercises for elderly patients with hemi -arthroplasty in early stage could effectively prevent and reduce the total perioperative blood loss and the incidence of high HBL.