CAJ | 학술논문

背景：隐性失血是骨科关节置换后常见话题，严重影响患者术后恢复及功能锻炼，多种因素与隐性失血有相关性，但具体机制尚未明确。 　　目的：探讨患者髋关节置换前一般状况(性别、年龄、基础疾病、肥胖)、置换过程中假体类型、置换时间与隐性失血的相关性，及隐性失血量与患者预后的相关性。 　　方法：纳入髋关节置换90例患者，置换前后监测患者红细胞比容、血红蛋白、凝血功能等多项血液学指标，统计患者身高、体质量、性别，根据Cross方程计算失血总量，后减掉显性失血，得到隐性失血的数值，根据文献报道，高于480 mL为高失血量组，低于480 mL为低失血量组，分析两组间性别、年龄、基础疾病、假体类型、置换时间等差异比较上述因素是否与隐性失血相关。并观测两组间围置换期并发症，术后1年短随访，观测两组间生存曲线。 　　结果与结论：根据分组标准，共39例患者纳入高失血量组，其中有64.1%的男性，64.1%的高血压患者，35.9%的糖尿病患者，7.7%的骨水泥假体患者，51例低失血量组患者仅有37.3%的男性患者，25.5%的高血压患者，5.9%的糖尿病患者，35.3%的骨水泥假体患者，上述数据差异均有显著性意义。提示年龄、高血压、糖尿病、假体类型均为隐性失血的独立相关影响因素，肥胖和吸烟史与隐性失血无明显相关性。两组患者术后住院时间及1年内生存率存在统计学差异。
배경：은성실혈시골과관절치환후상견화제，엄중영향환자술후회복급공능단련，다충인소여은성실혈유상관성，단구체궤제상미명학。 　　목적：탐토환자관관절치환전일반상황(성별、년령、기출질병、비반)、치환과정중가체류형、치환시간여은성실혈적상관성，급은성실혈량여환자예후적상관성。 　　방법：납입관관절치환90례환자，치환전후감측환자홍세포비용、혈홍단백、응혈공능등다항혈액학지표，통계환자신고、체질량、성별，근거Cross방정계산실혈총량，후감도현성실혈，득도은성실혈적수치，근거문헌보도，고우480 mL위고실혈량조，저우480 mL위저실혈량조，분석량조간성별、년령、기출질병、가체류형、치환시간등차이비교상술인소시부여은성실혈상관。병관측량조간위치환기병발증，술후1년단수방，관측량조간생존곡선。 　　결과여결론：근거분조표준，공39례환자납입고실혈량조，기중유64.1%적남성，64.1%적고혈압환자，35.9%적당뇨병환자，7.7%적골수니가체환자，51례저실혈량조환자부유37.3%적남성환자，25.5%적고혈압환자，5.9%적당뇨병환자，35.3%적골수니가체환자，상술수거차이균유현저성의의。제시년령、고혈압、당뇨병、가체류형균위은성실혈적독립상관영향인소，비반화흡연사여은성실혈무명현상관성。량조환자술후주원시간급1년내생존솔존재통계학차이。
BACKGROUND:Hidden blood loss, a frequent occurrence fol owing artificial joint replacement, greatly affects the recovery from total hip arthroplasty. Many factors have been shown to have a correlation with the hidden blood loss, but the specific mechanism is not yet clear. OBJECTIVE:To investigate the correlation of patients’ baseline (sex, age, underlying disease, obesity), prosthesis types, surgical time with hidden blood loss fol owing total hip arthroplasty, as wel as the association between hidden blood loss and prognosis. METHODS:Ninety patients undergoing total hip arthroplasty were enrol ed in this study. Using Gross formula, we calculated the total blood loss according to height, weight, and pre-and post-operative hematocrit, and subtracted the dominant loss of blood to get the quantitative value of hidden blood loss. According to the criterion, the 90 patients were divided to two groups:group I:volume of hidden blood loss>480 mL, group II:volume of hidden blood loss<480 mL. Then we analyze the difference in the gender, age, underlying disease, type of prosthesis, surgical time between the two groups, and whether there was a correlation between these factors and hidden blood loss. Al the patients were fol owed for 1 year. Perioperative complications and survival curves were observed and monitored in the two groups. RESULTS AND CONCLUSION:There were 39 patients in the group I, including 64.1%males, 64.1%hypertension patients, 35.9%diabetic patients, 7.7%patients receiving cement prosthesis;while, there were 51 patients in the group II, including 37.3%males, 25.5%hypertension patients, 5.9%diabetic patients, 35.3%patients receiving cemented prosthesis, showing a significant difference between the two groups. Based on these experimental findings, age, hypertension, diabetes mel itus, type of prosthesis were shown to be factors independently associated with hidden blood loss;however, obesity and smoking exhibited no correlation with hidden blood loss. In addition, a statistical difference in the survival rate was found at admission and during the 1-year fol ow-up.