髋关节置换住院期间输血的发生率及相关危险因素
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作者Author单位AddressE-Mail
廖贵 LIAO Gui 南宁市第一人民医院 广西医科大学第一附属医院, 广西 南宁 530000 The First People's Hospital of Nanning City, the First Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi, China  
蒙玉民 MENG Yu-min 南宁市第一人民医院 广西医科大学第一附属医院, 广西 南宁 530000 The First People's Hospital of Nanning City, the First Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi, China  
顾容赫 GU Rong-he 南宁市第一人民医院 广西医科大学第一附属医院, 广西 南宁 530000 The First People's Hospital of Nanning City, the First Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi, China 604303211@qq.com 
期刊信息:《中国骨伤》2024年,第37卷,第5期,第492-499页
DOI:10.12200/j.issn.1003-0034.20220529
基金项目:
中文摘要:

目的:探讨接受髋关节置换患者住院期间输血的发生率和危险因素。

方法:回顾性研究2019年1月至2021年12月收治的347例行髋关节置换患者临床资料,根据住院期间是否输血将患者分为输血组184例和非输血组164例。比较两组患者的基本病史资料、生化结果和手术情况,手术方式分为全髋关节置换术(total hip arthroplasty,THA)和半髋关节置换术(hemiarthroplasty,HA)。采用单因素分析和Spearman相关分析髋关节置换术患者输血的相关因素。对有统计学意义(P<0.05)的指标进行多因素Logistic回归分析,从而筛选髋关节置换患者住院期间输血的独立危险因素。绘制并比较髋关节置换患者、全髋关节置换患者、半髋关节置换患者术中出血量的受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under curve,AUC)及最佳阈值。

结果:纳入髋关节置换患者347例,其中全髋关节置换207例,半髋关节置换140例。总的髋关节置换患者、全髋关节置换患者、半髋关节置换患者的输血发生率分别为53.03%(184/347),53.14%(110/207),52.86%(74/140)。多因素Logistic回归分析显示,术前胱抑素C(OR=2.739,P=0.001),入院时血红蛋白(OR=0.960,P<0.000 1),术中出血量(OR=1.010,P<0.000 1),术后肺炎(OR=1.897,P=0.024),右侧髋关节置换(OR=2.277,P=0.002)是总的髋关节置换术患者的独立危险因素;入院时血红蛋白(OR=0.978,P=0.016),术中出血量(OR=1.012,P<0.000 1),术后肺炎(OR=2.769,P=0.013)是全髋关节置换的独立危险因素;入院时血红蛋白(OR=0.930,P<0.000 1)、术中出血量(OR=1.010,P<0.000 1)、术前胱抑素C(OR=2.277,P=0.023),右侧髋关节置换(OR=2.428,P=0.046)是半髋关节置换的独立危险因素。入院时血红蛋白和术中出血量是全髋和半髋关节置换的共同的危险因素,总的髋关节置换患者、全髋关节置换患者、半髋关节置换患者的AUC分别为0.688、0.778、0.652。

结论:术中出血量和术前血红蛋白是髋关节置换住院期间输血的重要危险因素,胱抑素C可能是髋关节置换住院期间输血的一个新的生物标志物。同时,鉴于髋关节置换中输血的高发生率和潜在风险,在住院期间应对确定的危险因素采取干预措施。
【关键词】全髋关节置换术  半髋关节置换术  输血  危险因素
 
Incidence of blood transfusion and associated risk factors during hip arthroplasty hospitalization
ABSTRACT  

Objective To investigate the incidence and risk factors of blood transfusion during hospitalization in patients receiving hip arthroplasty.

Methods Clinical data of 347 hip arthroplasty patients admitted between January and January 2019 and December 2021. Patients were divided into 184 patients in the transfusion group and 164 patients in the nontransfusion group according to whether they received blood transfusion during hospitalization. The basic medical history data,biochemical results and surgical conditions of the patients in two groups were collected and compared. They were divided into total hip arthroplasty (THA) and hemiarthroplasty (HA) according to the different surgical methods. One-way analysis and Spearman correlation were used to analyze the factors associated with blood transfusion in hip arthroplasty patients. Multi-factor logistic regression analysis was performed for statistically significant(P<0.05) indicators,thus screening for independent risk factors for blood transfusion during hospitalization in hip arthroplasty patients. The receiver operating characteristic(ROC) curves for intraoperative bleeding in all hip arthroplasty patients,total hip arthroplasty patients,and hemi arthroplasty patients were plotted and compared,and area under curve(AUC) and the optimal threshold were calculated.

Results A total of 347 patients were included for hip arthroplasty,including 207 total hip arthroplasty and 140 hemi arthroplasty. The transfusion rates of all hip arthroplasty patients,total hip arthroplasty patients and hemi arthroplasty patients were 53.03%(184/347),53.14%(110/207) and 52.86%(74/140),respectively. Multifactorial logistic regression analysis showed that preoperative cystatin C (OR=2.739,P=0.001),hemoglobin at admission (OR=0.960,P<0.000 1),intraoperative bleeding (OR=1.010,P<0.000 1),postoperative pneumonia (OR=1.897,P=0.024),and right hip arthroplasty (OR=2.277,P=0.002) were independent risk factors for all hip arthroplasty patients;hemoglobin at admission (OR=0.978,P=0.016),intraoperative bleeding (OR=1.012,P<0.000 1),and postoperative pneumonia (OR=2.769,P=0.013) were independent risk factors for total hip arthroplasty;hemoglobin at admission (OR=0.930,P<0.000 1),intraoperative bleeding (OR=1.010,P<0.000 1),preoperative cystatin C (OR=2.277,P=0.023),and right hip arthroplasty (OR=2.428,P=0.046) were independent risk factors for hemi arthroplasty. Hemoglobin on admission and intraoperative bleeding were common risk factors for total and hemi arthroplasty. The AUCs were 0.688,0.778,and 0.652 for total hip arthroplasty patients,total hip arthroplasty patients,and hemi arthroplasty patients,respectively.

Conclusion Intraoperative bleeding volume and preoperative hemoglobin are important risk factors for transfusion during hip arthroplasty hospitalization,and cystatin C may be a new biomarker for transfusion during hip arthroplasty hospitalization. At the same time,given the high incidence and potential risk of blood transfusion in hip arthroplasty,interventions should be made during hospitalization for identified risk factors.
KEY WORDS  Total hip arthroplasty  Hemi arthroplasty  Blood transfusion  Risk factors
 
引用本文,请按以下格式著录参考文献:
中文格式:廖贵,蒙玉民,顾容赫.髋关节置换住院期间输血的发生率及相关危险因素[J].中国骨伤,2024,37(5):492~499
英文格式:LIAO Gui,MENG Yu-min,GU Rong-he.Incidence of blood transfusion and associated risk factors during hip arthroplasty hospitalization[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(5):492~499
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