| Objective：To research a series clinical cases of intertrochanteric fraturewhich are treated with Proximal Femoral Nail Anti-rotation(PFNA)，and toenhance the clinical realization of hidden blood loss；By getting the date ofHCT before and after the operation,to make dynamic statistical description ofthe results and to provide a theoretical basis for postoperative bloodtransfusion in clinical work.Methods:A retrospective case series of38(male20, female18) patientswith an average of78year, operated between July2012and February2013was reviewed，Divided into transfusion group (10cases), blood transfusion400ml group (16cases), transfusion of800ml (12cases), the threegroups.Comparing hematocrit (HCT) in each group of patients before andafter the operation； Gross formula to calculate the total red blood cell loss：(Total red blood cell volume loss)=preoperative blood volume (Patient bloodvolume PBV)×(preoperative HCT-Postoperative HCT).ross formula usingperioperative the average HCT calculated circulating blood volume, and itsaccuracy has been verified in practice, and orthopedic assessment of otherelective surgical trauma has been widely used； theoretical the hemorrhagictotal=the total amount of red blood cells lost/preoperative HCT；perioperative blood loss=hidden blood loss+the dominant blood loss=theoretical total blood loss+blood transfusion.； the recessive blood lossamount=theoretical total blood loss+blood transfusion-dominant bloodloss. And hidden blood loss calculated for each group and its proportion in thetotal amount of blood loss, statistical analysis, and of HCT the value of eachgroup before and after surgery;1day before surgery, after1-3days dailyreview of blood according to blood loss and postoperative routine blood testresults to determine whether the need for blood transfusion. The observed changes in each group before and after surgery HCT dynamic analysis of theresults, and for the statistical description. And Review About intertrochantericfracture treatment and clinical outcomes of the medical literature as asupplement in recent years.Results: Collected a total of38patients, including20males and18females, aged66to87, the average age (78±2.19) years.150~~171cm tall,average (160.78±2.77) cm;50~~80kg body weight, body mass index,18.96to28.58, the average (24.95±1.25). Total blood loss without transfusiongroup671.2ml, hidden blood loss was499.9, the mean preoperativehematocrit (HCT)33.43±3.00, mean postoperative hematocrit (HCT) for28.59±2.42, the average change in value of4.84, the implicit hemorrhagic in71.2%of the total blood loss; transfusion400ml total blood loss978.0, therecessive blood loss611.2ml transfusion400ml preoperative hematocrit (HCT)32.90±1.27, mean postoperative hematocrit (HCT) was26.51±2.11, theaverage change in value of6.39, occult blood loss in56.8%of the totalamount of blood loss; transfusion800ml total blood loss was1020.0, therecessive blood loss740.0average hematocrit, preoperative transfusion800mlgroup (HCT) for32.22±2.38, mean postoperative hematocrit (HCT) was28.86±2.81, mean change in value of3.36,68.7%of the the recessive bloodloss in the total amount of blood loss. No blood transfusion group and bloodtransfusion400ml surgery before and after HCT compared, the differencewas statistically significant (P <0.05);800ml surgery before and aftertransfusion HCT compared, the difference was not statistically significant (P>0.05).1-3days after operation，review routine blood to determine the need forblood transfusion blood loss and postoperative blood count results.Observation of each post-operative changes in the HCT, Table1.The figure shows the postoperative male on the second day, the womenin the first three days of the check routine blood HCT value of minimum andtherefore prompt clinical one day after HCT does not mean that patientswithout anemia in the normal range, but should be routine surgery2,3days after the review of blood. Based on reported results given appropriatetransfusion therapy.Conclusion: The trauma of a hip fracture clearly leads to blood loss, butthis will not necessarily result in a decrease in haemoglobin for the first hours.The primary factor leading to an overestimation of the patient’s totalhaemoglobin mass on admission is pre-fracture dehydration. In our analysiswe made calculations to establish the impact of dehydration of10%in allpatients on admission (a mean deficit of6l). The results showed a potentialexaggeration of the blood loss in intracapsular fractures, whereas that in theother procedures was from800ml to1400ml in excess of the loss observedintra-operatively. A multivariate analysis on the corrected values for totalblood loss showed similar levels of significance for the individual risk factorsas in the original model.Fluid retention after surgery can be in the order ofseveral litres, which could lead to an underestimation of the final haemoglobinconcentration and, thus, an exaggeration of total blood loss.16The mean intra-operative intravenous fluid administered was1066ml (100to4000). Tominimise the effect of fluid retention the final haemoglobin was measured onthe third or fourth post-operative day, when fluid retention may be lessprominent than in the earlier postoperative period. However, any fluidretention leads to a larger blood volume than that used in the calculations,which would give an underestimation of post-operative blood loss. On balance,the calculation methods used seem to be acceptable and to provide areasonable estimate of total blood loss with a possible bias towards anoverestimation in procedures with parallel implants.Due to the hidden nature of hidden blood loss, clinical easily beoverlooked. Hidden blood loss will result in varying degrees of anemia, severeanemia can cause the body’s metabolic disorders induced cardiovascular andcerebrovascular accidents reported preoperative hemoglobin (Hb)80~100g/L mortality; Hb <60g/L mortality rate of61%. Hidden blood loss played abig role in the postoperative Hb decline, senile intertrochanteric fracturepatients to closely monitor the patient’s Hb, HCT dynamic changes, pay attention to supplement the patient’s circulating blood volume, correct anemia,reduce recessive the harm caused by blood loss, help patients smoothperioperative period. |
PDF Full Text Request