摘要
目的比较合并与不合并类风湿性关节炎(RA)的腰椎滑脱症患者腰椎后路减压融合术(PLIF)术中出血量、术后引流量及隐性失血(HBL),探讨RA患者术中HBL的相关因素。方法回顾性纳入2014年1月至2019年4月在菏泽市立医院接受治疗的50例合并RA的腰椎滑脱症患者(RA组),同时期筛选73例未合并RA的患者(NRA组)。分析比较两组基本信息、RA信息、手术情况以及出血量相关指标。以术中出血量、术后引流量和HBL作为主要结果;手术时间、术前术后血细胞比容(Hct)和血红蛋白(Hb)及其变化值、手术前后贫血数量、术后新发贫血数量、自体血和异体血输注量等作为次要结果。应用多元线性回归模型分析RA组HBL的相关因素。结果RA组男9例,女41例,年龄(62±7)岁;NRA组男11例,女62例,年龄(64±9)岁。RA组病程为(14.4±11.2)年,其中单药或联合口服改变病情抗风湿药(DMARDs)者最常见,两组在椎弓根螺钉数和椎间融合器置入上差异均无统计学意义,围手术期并发症发生率相当。两组在总失血量(TBL)、术中出血量和术后引流量等差异均无统计学意义[(693±315)ml比(630±365)ml、(454±373)ml比(414±375)ml和(653±376)ml比(675±400)ml,t=1.072、0.388、-0.189,均P>0.05],而HBL及HBL所占TBL比例在NRA组中更低(t=6.157、2.965,均P<0.05)。根据手术节段数进行分层分析,长节段(≥3节段)手术中NRA组中HBL和HBL所占TBL比例均优于RA组。次要结果对比Hct改变值在NRA组小于RA组(P=0.031),但两组Hb减小值差异无统计学意义(P>0.05);术后两组新发贫血以及贫血加重差异无统计学意义,异体血输注和手术时间差异也无统计学意义(均P>0.05)。RA的Steinbrocker级别高、未服用DMARDS、Hb变化和输注异体血为HBL的独立相关因素(β=0.363、-0.272、0.210、1.204,均P<0.05)。结论RA组和NRA组在TBL、术中出血、术后引流和手术时间上无差异,而HBL以及HBL所占TBL比例在RA组高于NRA组;RA组
Objective To compare the intraoperative blood loss,postoperative drainage and hidden blood loss(HBL)in lumbar posterior lumbar interbody fusion(PLIF)in patients with and without rheumatoid arthritis(RA),and analyze the relevant factors of HBL in RA patients.Methods Fifty patients with RA(RA group)and 73 patients without RA(NRA group)treated in the Heze Municipal Hospital from January 2014 to April 2019 were enrolled in this study.The basic information,RA information,operation and related blood loss indicators in the two groups were compared.The intraoperative blood loss,postoperative drainage and HBL were the main results.The secondary results were operation time,preoperative and postoperative hematocrit(Hct)and hemoglobin(Hb)and their variation values,cases of anemia before and after surgery,number of new anemia after surgery,autologous blood and allogeneic blood transfusion,etc.The correlation factors of HBL in RA group were analyzed by multi-linear regression model.Results There were 9 males and 41 females with a mean age of(62±7)years in RA group;and 11 males and 62 females with a mean age of(64±9)years in NRA group.The course of disease in RA group was(14.4±11.2)years,the most common anti-rheumatism drug(DMARDs)were single-drug and combined oral.There was no significant differences between the two groups in the number of vertebral bow screws and intervertebral fusion device.The incidence of surgical complications was comparable between the two groups.Differences between the two groups in total blood loss(TBL),intraoperative blood loss,and postoperative drainage were not statistically significant((693±315)ml vs(630±365)ml,(454±373)ml vs(414±375)ml and(653±376)ml vs(675±400)ml,t=1.072,0.388,-0.189,all P>0.05),while the HBL and the percentage of HBL in TBL were lower in the NRA group(t=6.157,2.965,both P<0.05).According to the layered analysis of the number of surgical segments,the proportion of HBL and the HBL percentage of TBL in the NRA group for the long section(≥3 segments)surgery were better th
作者
楚超
苏洪民
韩哲
刘玉亮
沙启乐
徐帅
谭瑞义
何银锋
Chu Chao;Su Hongmin;Han Zhe;Liu Yuliang;Sha Qile;Xu Shuai;Tan Ruiyi;He Yinfeng(Department of Spinal Surgery,Heze Municipal Hospital,Heze 274000,China;Department of Spinal Surgery,Peking University People's Hospital,Beijing 100044,China;Department of Radiology,Peking University Peopled Hospital,Beijing 100044,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第11期792-797,共6页
National Medical Journal of China
关键词
关节炎
类风湿
腰椎滑脱症
腰椎后路减压融合术
术中出血量
Arthritis,rheumatoid
Lumbar spondylolisthesis
Posterior lumbar interbody fusion
Intraoperative blood loss
