| Objective: In recent years,the hidden blood loss has become a hot topicof clinical doctor to discuss,And the hidden blood loss is easy to ignore.Theoperation chance,postoperative function exercise and prognosis is closelyrelated with the hidden blood loss.So more and more.attention has been payby surgeons.Preoperative hidden blood loss can not be ignored,Preoperativehidden blood loss can not be ignored and more related research.But theresearch for the preoperative hidden blood loss is rather little.In this study,wethrough to the patients preoperative routine blood test of unilateral closedfemoral shaft fracture,Observe the regulation of the recessive loss of blood,wecan realize the patients’illness change and blood loss more accurate,and treatanemia in time.Then we can reduce the blind time of blood routineexamination.And provide theoretical support for the adequate preoperativepreparation.Method:50patients with one side of femoral shaft fractures wereadmitted from March2013to March2014in our hospital.Patients of femoralfractures include27males and23females,aged from20to80years,at theaverage of53.3years.In these patients,23cases of traffic accident injury,11cases of fall,16cases of high falling injury.First of all,we make a AO/OTAclassification of femoral fractures through the X line,the cases are included bythis way, Type32-A15cases,type32-B24cases,type32-C11cases.Elderlygroup (age≥60years)21cases，include9males and12females;non-elderlygroup (20years＜age＜60years)29cases,include918males and11females.All the cases are the first fresh unilateral femoral fractures,good skincondition， and the exclusion criteria included other fractures,trauma,apre-injury diagnosis of anaemia,other parts of blood loss like gastrointestinalbleeds,diseases of blood system,cases of preoperative blood transfusion.All the patients were got blood routine examination post-injury1-6days,andrecorded hemoglobin(HGB),hematocrit(HCT),height(cm)and weight(kg)，control the therapeutic intravenous rehydratio before the operation.Accordingto Gross equation,the preoperative hidden blood loss can be calculated byheight,weight and the different of hematocrit(HCT)from two times.Observethe decline of the patients’average hemoglobin and the time when theminimum appear.Understand the impact of gender, age factors on the bloodloss.SPSS13.0statistics software was used for t-test,and six consecutive daysof hemoglobin and hematocrit of femoral fractures were made for statisticsanalysis,the different was statistically significant(P＜0.05).And excel mappingsoftware can be used to draw histogram for correlated parameter comparison.Results:The everyday blood routine index HGB and HCT of50femoralshaft fractures patients with hidden blood loss has a certain regulation: thelowest HGB and HCT appear in the fifth day,and the difference between thefirst-day and fifth-day are10.08%and34.66g/L.The routine blood indexdecline gradually from1day to5day,The lowest value is the fifth day,Elevatedin the sixth day.The male and female maximum difference of blood routineindex is the difference which the first day minus the fifth day.The male groupHGBd1-5is34.96g/L and the HCTd1-5is10.27%;and The female groupHGBd1-5is32.16g/L g/L and the HCTd1-5is9.78%. The blood loss of maleand female is1225.6ml and1133.8ml calculated by Gross equation. Thedifference of blood routine index HGB and HCT increase gradually from1day to5day and the difference decreases on the sixth day.We statisticalanalysis of male and female patients blood routine indexes,P＞0.05,thedifference between male and female is not statistically significant.We can’tfind the difference between male and female.The elderly-group maximumdifference of blood routine index is the difference which the first day minusthe forth day.The HGBd1-5is38.84g/L and the HCTd1-5is11.86%,The bloodloss is1335.3ml calculated by Gross equation. The non-elderly-groupmaximum difference of blood routine index is the difference which the firstday minus the fifth day. The HGBd1-5is30.42g/L and the HCTd1-5is 9.23%,The blood loss is1073.7ml calculated by Gross equation.Theelderly-group and non-elderly-group difference of blood routine indexdecreases gradually from the forth day and the fifth day.We statisticalanalysis of elderly-group and non-elderly-group patients blood routine indexes,P＜0.05,the difference between male and female is statisticallysignificant.We can find the difference between male and female,and thehidden blood loss of the elderly-group is significantly greater than thenon-elderly-group.Conclusion:The patients of femoral shaft fractures loss more hiddenblood, then, hurt by the first day of routine blood index can’t immediatelyreflect the blood loss in patients. What′s more, blood routine index decreasegradually along with the increase of the hospitalized days. This researchshows that: patients in non elderly group for4days after injury commonlymeasured average hemoglobin is low, the elderly group patients for5daysafter injury commonly measured average hemoglobin is low. Compare withnon elderly group patients, elderly group patients loss more blood and faster.Therefore, the hidden blood less should be given in patients of femoral shaftfractures, regular review of routine blood, promptly take appropriate measuresto correct the anemia, create conditions for timely surgery, and thus reduce thepreoperative and postoperative complications. |
