肥胖与膝关节表面置换术围手术期失血的相关性研究
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摘要
目的探讨肥胖对膝关节置换术围手术期失血量的影响。方法 116例择期行膝关节表面置换术患者,根据体质量指数(body mass index, BMI)分为正常组(BMI<24.00 kg/m~2)62例、超重组(24.0≤BMI<28 kg/m~2)31例和肥胖组(BMI≥28 kg/m~2)23例。比较3组围手术期失血总量、显性失血量和隐性失血量;采用Pearson相关性分析肥胖与围手术期失血量的相关性。结果正常组失血总量[(864.39±29.62)mL]、显性失血量[(354.65±40.09)mL]和隐性失血量[(509.74±25.76)mL]少于超重组[(1 094.94±30.35)、(454.84±47.39)、(640.10±32.91)mL]和肥胖组[(1 213.78±76.28)、(441.00±79.05)、(772.78±30.16)mL)](P<0.05);超重组失血总量、隐性失血量少于肥胖组(P<0.05),显性失血量与肥胖组比较差异无统计学意义(P>0.05);肥胖与围手术期失血总量、显性失血量、隐性失血量增加均呈正相关(r=0.832,P=0.046;r=0.472,P=0.041;r=0.872,P=0.035)。结论肥胖患者膝关节置换术围手术期失血风险较高,应注意隐性失血量增加。
Objective To investigate the influence of obesity on perioperative blood loss in knee arthroplasty. Methods Totally 116 patients receiving knee arthroplasty were divided into 62 patients with body mass index(BMI)<24.00 kg/m~2(normal group), 31 with BMI 24.0 to 28 kg/m~2(overweight group) and 23 with BMI≥28 kg/m~2(obesity group) according to BMI value. The total blood loss, dominant blood loss and hidden blood loss were compared among three groups. Pearson correlation analysis was adopted to study the relationship between obesity and perioperative blood loss. Results The total blood loss((864.39±29.62) mL), dominant blood loss((354.65±40.09) mL) and hidden blood loss((509.74±25.76) mL) in normal group were significantly less than those in overweight group((1 094.94±30.35),(454.84±47.39),(640.10±32.91) mL) and obesity group((1 213.78±76.28),(441.00±79.05),(772.78±30.16) mL)(P<0.05). The total blood loss and hidden blood loss were significantly less in overweight group than those in obesity group(P<0.05), and the dominant blood loss showed no significant difference between two groups. Obesity was positively correlated with the perioperative total blood loss, dominant blood loss and hidden blood loss(r=0.832, P=0.046; r=0.472, P=0.041; r=0.872, P=0.035). Conclusion Obese patients suffer a higher risk of perioperative blood loss in knee arthroplasty, and the increase of hidden blood loss should be paid more attention.
Objective To investigate the influence of obesity on perioperative blood loss in knee arthroplasty. Methods Totally 116 patients receiving knee arthroplasty were divided into 62 patients with body mass index(BMI)<24.00 kg/m~2(normal group), 31 with BMI 24.0 to 28 kg/m~2(overweight group) and 23 with BMI≥28 kg/m~2(obesity group) according to BMI value. The total blood loss, dominant blood loss and hidden blood loss were compared among three groups. Pearson correlation analysis was adopted to study the relationship between obesity and perioperative blood loss. Results The total blood loss((864.39±29.62) mL), dominant blood loss((354.65±40.09) mL) and hidden blood loss((509.74±25.76) mL) in normal group were significantly less than those in overweight group((1 094.94±30.35),(454.84±47.39),(640.10±32.91) mL) and obesity group((1 213.78±76.28),(441.00±79.05),(772.78±30.16) mL)(P<0.05). The total blood loss and hidden blood loss were significantly less in overweight group than those in obesity group(P<0.05), and the dominant blood loss showed no significant difference between two groups. Obesity was positively correlated with the perioperative total blood loss, dominant blood loss and hidden blood loss(r=0.832, P=0.046; r=0.472, P=0.041; r=0.872, P=0.035). Conclusion Obese patients suffer a higher risk of perioperative blood loss in knee arthroplasty, and the increase of hidden blood loss should be paid more attention.
引文
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[2] 李坤,闻振坤,郭建斌,等.膝关节置换术治疗膝关节外翻畸形19例临床分析[J].中华实用诊断与治疗杂志,2018,32(4):362-364.
[3] 崔苛苛,杨伟毅,刘军,等.全程出血管理在膝关节单髁置换中的临床应用[J].中国组织工程研究,2018,22(3):336-342.
[4] 刘丙根,庞清江.关节置换术中围手术期失血量的计算方法[J].中国骨与关节杂志,2015,4(6):504-508.
[5] 严建锋,李强,杨宗华.老年关节置换患者体质量指数及血脂水平与围置换期血液管理的相关性[J].中国组织工程研究,2017,21(35):5609-5615.
[6] 李军,周云,荆珏华,等.两种抗凝药物对人工全髋关节置换术隐性失血的影响比较[J].中国修复重建外科杂志,2013,27(4):432-435.
[7] 解彩霞,苏燕.红细胞内peroxiredoxin-2抗氧化作用研究进展[J].中国输血杂志,2016,29(5):542-544.
[8] 吴鑫杰,谭明生.充气式止血带在全膝关节置换术中应用的研究进展[J].中国矫形外科杂志,2018,26(17):1601-1604.