斜外侧腰椎椎体间融合术隐性失血的多因素分析
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福建医科大学附属第二医院

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Multi-factor analysis of hidden blood loss in oblique lumbar lumbar interbody fusion
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Fujian Medical University 2nd Affiliated Hospital

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    摘要:

    摘要:[目的]分析斜外侧腰椎椎体间融合术(Oblique lumbar interbody fusion, OLIF)治疗腰椎退变性疾病术后隐性失血及相关影响因素。[方法]回顾性分析2016年5月~2019年12月本院采用OLIF治疗腰椎退变性疾病的患者45例,记录术前,术后2天的红细胞压积、血红蛋白及术中、术后显性出血量,使用Nadler和Gross方程计算得出隐性失血量,对患者性别、年龄、体重指数、糖尿病、高血压、手术时间、手术节段数、学习曲线、植骨类型、氨甲环酸使用、脊柱畸形进行分组采用秩和检验比较,采用多元线性逐步回归分析筛选出相关影响因素。[结果]本研究中平均总失血量(758.95±393.05)ml、平均显性失血量(120.78±108.31)ml、平均隐性失血量(638.17±371.75)ml,占总失血量(81.09±16.54)%,患者术后Hb和Hct均有不同程度的下降,术前术后比较P<0.001,差异有统计学意义,秩和检验结果表明手术时间、学习曲线、氨甲环酸使用对隐性失血量有统计学意义(P<0.05),而多元线性逐步回归分析中显示学习曲线、氨甲环酸使用是OLIF隐性失血量的影响因素。[结论]OLIF技术治疗腰椎退变性疾病存在较多的隐性失血,隐性失血量与学习曲线、氨甲环酸使用密切相关,需引起临床医师的重视。

    Abstract:

    Abstract: [Objective] To analyze the hidden blood loss and related factors after oblique lumbar interbody fusion for lumbar degenerative diseases. [Methods] A retrospective analysis was performed on 45 patients with lumbar degenerative disease treated by OLIF in our hospital from May 2016 to December 2019. Hematocrit, hemoglobin and intraoperative and postoperative dominant blood loss were recorded before and 2 days after operation. The hidden blood loss was calculated by Nadler and Gross equation. The patients were grouped by gender, age, body mass index, diabetes, hypertension, operation time, number of surgical levels, learning curve, type of bone graft, use of tranexamic acid, and spinal deformity. Rank-sum test was used to compare the relevant factors. [Results] In this study, the average total blood loss was (758.95±393.05)ml, the average dominant blood loss was (120.78±108.31)ml, and the average hidden blood loss was (638.17±371.75) ml, accounting for (81.09±16.54)% of the total blood loss. Postoperative hemoglobin and Hematocrit decreased to varying degrees. The rank-sum test results showed that the operative time, learning curve and use of tranexamic acid had statistical significance on hidden blood loss (P < 0.05), and multiple linear stepwise regression analysis showed that learning curve and use of tranexamic acid were the influencing factors of hidden blood loss in OLIF. [Conclusion] There is a lot of hidden blood loss in the treatment of lumbar degenerative diseases with OLIF technique. Hidden blood loss is closely related to learning curve and use of tranexamic acid, which should be paid attention to by clinicians.

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  • 收稿日期:2021-07-21
  • 最后修改日期:2021-10-24
  • 录用日期:2022-02-09
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