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闭合股骨干骨折修复术前隐性失血的规律 预览 被引量:10

Regularity of hidden blood loss before repair of closed femoral shaft fractures
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摘要 背景:手术时机的把握、术后功能锻炼及预后情况同隐性失血密切相关,因此骨科临床对骨折隐性失血的关注越来越多。骨折修复围手术期存在不可忽视的隐性失血,相关研究较多,而对于骨折修复术前隐性失血的研究较少。目的:通过对临床单侧闭合股骨骨折患者修复术前血常规的检测,观察隐性失血的规律,以期更准确的了解患者病情变化及失血量,及时纠正贫血。方法:选择2013年3月至2014年3月收治的初次单纯一侧股骨干骨折患者50例,其中男27例,女23例;老年组(≥60岁)21例,非老年组(〈60岁)29例。入院后于早晨抽空腹血液测血常规,记录修复术前1-6 d血常规中的血红蛋白、红细胞压积,观察患者每天平均血红蛋白、红细胞压积的下降程度以及最低值出现的时间,了解患者失血量情况。结果与结论:50例股骨干骨折患者入院后每日血常规指标血红蛋白、红细胞压积均有一定的规律性:患者红细胞压积、血红蛋白最低值均出现在第5天,第1天与第5天的差值分别为10.08%,34.66 g/L,第1天至第5天血常规指标值逐渐下降,第5天达最低,第6天升高。老年组患者血常规指标的最大差值为第1天与第4天的差值,即血红蛋白d1-4为38.84 g/L,红细胞压积d1-4为11.86%,计算失血量为1 335.3 m L;非老年组患者血常规指标最大差值为第1天与第5天的差值,即血红蛋白d1-5为30.42 g/L,红细胞压积d1-5为9.23%,计算失血量为1 073.7 m L。老年组和非老年血常规指标差值分别从第5天和第6天开始降低。对老年组和非老年组血常规指标值进行比较,差异有显著性意义(P〈0.05),老年组隐性失血量明显大于非老年组。提示股骨干骨折患者修复术前隐性失血量较多,而受伤第1天测得的血常规指标不能立即反映当时的失血量,血常规指标随着入院天数的增加而降低。同时,老年组患者失血量较非老年组患者多,� BACKGROUND: The timing of surgery, postoperative functional exercise and prognosis are strongly associated with hidden blood loss. Therefore, clinical orthopedics pays more and more attention on hidden blood loss after fracture. Hidden blood loss that cannot be ignored exists during perioperative fracture repair, which has been investigated by many studies. Hidden blood loss before repair has been seldom investigated. OBJECTIVE: To observe the regularity of hidden blood loss so as to precisely understand the changes of illness and blood loss and to treat anemia in time by blood routine examination before repair in patients with unilateral closed femoral shaft fracture. METHODS: A total of 50 patients with unilateral femoral shaft fractures were selected from March 2013 to March 2014, including 27 males and 23 females. There were 21 cases in the elderly group (≥ 60 years) and 29 cases in the non-elderly group (〈 60 years). Fasting blood was extracted in the morning after admission for blood routine examination Hemoglobin and hematocrit were recorded at 1-6 days before repair. Average decreasing degree and the time of minimum value appearance of hemoglobin and hematocrit were observed every day. Blood loss was known. RESULTS AND CONCLUSION: The everyday blood routine index (hemoglobin and hematocrit) in 50 patients with femoral shaft fractures after admission has certain regularity. The lowest hemoglobin and hematocrit appeared at 5 days. The difference between the first-day and fifth-day was separately 10.08% and 34.66 g/L. The routine blood index declined gradually from the first day to fifth day. The lowest value appeared on the fifth day, and the highest value appeared on the sixth day. The difference of the first day value and the fourth day value was the maximum difference of blood routine index in the elderly group. The hemoglobin d1-4 was 38.84 g/L and the hematocrit d1-4 was 11.86%. The amount of blood loss was 1 335.3 mL. The difference of the first day value and the fifth day valu
作者 王利伟 王洪炳 闫金成 张开 古雪建 李长江 史福东 Wang Li-wei, Wang Hong-bing, Yan Jin-cheng, Zhang Kai, Gu Xue-jian, Li Chang-jiang, Shi Fu-dong (1Tangshan People's Hospital, Tangshan 063000, Hebei Province, China; 2Second Affiliated Hospital, Xingtai Medical College, Xingtai 054000, Hebei Province, China; 3Third Hospital, Hebei Medical University Shijiazhuang 050000, Hebei Province, China)
出处 《中国组织工程研究》 CSCD 2014年第53期8623-8628,共6页 Journal of Clinical Rehabilitative Tissue Engineering Research
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