本文選題：股骨轉(zhuǎn)子間骨折　切入點：手術后出血　出處：《廣州中醫(yī)藥大學》2015年碩士論文

【摘要】：目的：通過對采用股骨近端防旋髓內(nèi)釘(proximal femoral nail anti-rotation, PFNA)治療的股骨轉(zhuǎn)子間骨折患者進行各種失血量的分析,來驗證其術后隱性失血的存在,并探討隱性失血與各種影響因素之間的相關性,從而更好地指導臨床。方法：采用前瞻性描述分析方法,對2013年01月至2015年02月期間在廣東省中醫(yī)院骨科病房住院,嚴格按照相關的診斷標準、納入標準和排除標準選擇出208例患者進行分析。記錄每例患者的性別、身高、體重、輸血情況、術前和術后的血常規(guī)、顯性失血情況等資料,利用Gross方程和Nadler提供的方程等,計算出每個PFNA內(nèi)固定術后患者的總失血量、顯性失血量和隱性失血量,并分析隱性失血量與患側、性別、年齡、BMI (Body Mass Index)、骨折類型、手術用時、糖尿病、高血壓病、受傷至手術的時間、是否使用注射用燈盞花素等因素的相關性。結果：本研究中患者從受傷至手術期間的平均時間為(5.76±2.830)天,手術用時平均為(69.76±21.67)min,術后出現(xiàn)HCT最低的時間平均是術后(3.21±1.04)天,實際失血總量(773.16±289.65)mL,隱性失血量(658.39±259.15)mL。隱性失血量占實際失血總量的84.7%,且與骨折類型、性別、糖尿病、手術用時、高血壓病等因素顯著性相關(P0.05),有顯著性影響的變量從大到小依次為骨折類型,性別,糖尿病,手術用時,高血壓病。結論：股骨轉(zhuǎn)子間骨折患者行PFNA內(nèi)固定術后存在較多的隱性失血,且與骨折類型、性別、糖尿病、手術用時、原發(fā)性高血壓等因素有顯著性相關性,臨床工作中,我們必須意識到隱性失血量的存在,及時復查血容量,必要時給予輸血處理,特別是出現(xiàn)多個與隱性失血有顯著相關的危險因素時,從而減少并發(fā)癥,提高臨床療效。
[Abstract]:Objective: through the use of proximal femoral nail anti rotation (proximal femoral nail anti-rotation, PFNA) of various blood loss in patients of femur for the treatment of the fracture, to verify the existence of hidden blood loss after surgery, and explore the relationship between hidden blood loss and various influence factors, so as to better guide the clinical method. Description: a prospective analysis of hospitalized in the Department of orthopedics of Guangdong Province Traditional Chinese Medical Hospital ward during 2013 01 to 2015 02 months, in strict accordance with the relevant diagnostic criteria, inclusion criteria and exclusion criteria selected 208 cases of patients were analyzed. Records of each patient's gender, height, weight, blood transfusion, preoperative and postoperative blood routine, blood explicit data, using the Gross equation and the Nadler equation, calculate each PFNA after internal fixation in patients with total blood volume, dominant blood loss and hidden blood loss The analysis, and the hidden blood loss and the affected side, gender, age, BMI (Body Mass Index), the type of fracture, surgery, diabetes, hypertension, injury to operation time, whether the use of injectable breviscapine related factors. Results: the average time of patients during the study from injury to surgery for (5.76 + 2.830) days, the average operation time was (69.76 + 21.67) min, postoperative HCT the lowest average postoperative time (3.21 + 1.04) days, the actual total blood loss (773.16 + 289.65) mL, occult blood loss (658.39 + 259.15) mL. occult blood loss accounted for the total blood loss 84.7%, and fracture type, sex, diabetes, surgery, hypertension and other factors significantly related (P0.05), has a significant impact of the variables are fracture type, from large to small gender, diabetes, surgery, hypertension. Conclusion: patients who underwent PFNA internal fixation for intertrochanteric fracture Are there hidden blood loss after surgery, and fracture type, sex, diabetes, surgery, there was significant correlation between the factors of primary hypertension, clinical work, we must be aware of the existence of hidden blood loss, timely review of blood volume, blood transfusion for treatment when necessary, especially the appearance of more than one and there are significant risk factors of hidden blood loss related, so as to reduce the complications and improve the curative effect.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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