标题：老年股骨转子间骨折内固定术后营养状况评估及其围术期隐性失血状况分析

      作者：李亚利，桂萍    空军军医大学第二附属医院骨科，陕西 西安 710038

      卷次： 2019年30卷24期

      【摘要】 目的 评估老年股骨转子间骨折患者内固定术后的营养状况，并分析其围术期隐性失血情况，为患者的临床诊疗提供指导。方法 回顾性分析2017年9月至2018年7月间空军军医大学第二附属医院骨科收治的120例老年股骨转子间骨折患者内固定术后的诊疗状况。按不同的营养状态对患者进行分组，其中60例营养良好者为对照组，60例营养不良者为观察组。比较两组患者围手术期的隐性失血量、血红蛋白水平和红细胞比容(Hct)。结果 观察组患者的入院即刻隐性失血量、术前隐性失血量及术后隐性失血量分别为(197.3±43.1) mL、(178.4±38.2) mL、(88.4±6.5) mL，明显大于对照组的(82.5±11.2) mL、(75.8±6.2) mL及(39.8±8.2) mL，差异均有统计学意义(P<0.05)；观察组患者的入院即刻血红蛋白、术前血红蛋白及术后血红蛋白水平分别为(90.8±17.6) g/L、(84.6±14.3) g/L、(78.4±11.5) g/L，明显低于对照组的(118.5±11.5) g/L、(108.4±12.1) g/L、(93.2±8.2) g/L，差异均有统计学意义(P<0.05)；观察组患者术后第一天、术后第二天及术后第三天的Hct分别为(28.32±2.2)%、(27.06±2.7)%、(27.61±2.6)%，明显低于对照组的(34.12±3.4)%、(32.24±2.8)%、(31.32±3.2)%，差异均有统计学意义(P<0.05)。结论 老年患者股骨转子间骨折后随营养状况的恶劣隐性失血量逐渐增加，血清指标如总蛋白和白蛋白可用于评估老年人股骨转子间骨折内固定后的隐血失血。
      【关键词】 股骨转子间骨折；内固定；围术期；隐性失血；营养状况
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2019）24—3194—03

Nutritional status evaluation and perioperative occult blood loss analysis of elderly patients with intertrochantericfracture after internal fixation.
LI Ya-li, GUI Ping. Department of Orthopaedics, the Second Affiliated Hospital of AirForce Military Medical University, Xi'an 710038, Shaanxi, CHINA
【Abstract】 Objective To evaluate the nutritional status of elderly patients with intertrochanteric fracture afterinternal fixation, and analyze the occult blood loss in perioperative period, so as to provide guidance for the clinical diag-nosis and treatment of patients. Methods The diagnosis and treatment of 120 elderly patients with intertrochantericfracture after internal fixation in Department of Orthopaedics, the Second Affiliated Hospital of Air Force Military Medi-cal University from September 2017 to July 2018 were analyzed retrospectively. The patients were divided into twogroups according to different nutritional status: 60 in good nutrition status were in the control group and 60 in poor nu-trition status were in the observation group. The occult blood loss, hemoglobin level and hematocrit were compared be-tween the two groups. Results The occult blood loss on admission, before operation, after operation in the observa-tion group were (197.3±43.1) mL, (178.4±38.2) mL, (88.4±6.5) mL, respectively, which were significantly higher thancorresponding (82.5±11.2) mL, (75.8±6.2) mL, (39.8±8.2) mL in the control group (all P<0.05); the levels of hemoglo-bin on admission, before opearation, after operation in the observation group were (90.8±17.6) g/L, (84.6±14.3) g/L,(78.4±11.5) g/L, respectively, which were significantly lower than corresponding (118.5±11.5) g/L, (108.4±12.1) g/L,(93.2±8.2) g/L in the control group (all P<0.05); the hematocrit of the patients in the observation group on the first day,the second day and the third day were (28.32±2.2)%, (27.06±2.7)%, (27.61±2.6)%, which were significantly lower thancorresponding (34.12±3.4)%, (32.24±2.8)%, (31.32±3.2)% in the control group (all P<0.05). Conclusion The amountof occult blood loss in elderly patients with intertrochanteric fracture increased gradually with poor nutritional status, theserum indexes such as total protein and albumin can be used to evaluate occult blood loss after internal fixation of femo-ral intertrochanteric fracture in the elderly.
      【Key words】 Intertrochanteric fracture; Internal fixation; Perioperative period; Occult blood loss; Nutritional status