| Objective: To study a series of clinical cases of femoral intertrochanteric fracture in old patients, and to enhance the clinical realization of preoperative hidden blood loss.Methods: From a list of 41 patients with intertrochanteric fracture from January 2014 to September 2014 except for 4 cases of preoperative blood transfusion.37 patients with intertrochanteric fracture include 11 males and 26 females,aging from 67 to 95,at the average of 81 years.According to Evans-Jensen classification, there were type Ia in one case, type Ib in 5 cases,type IIa in 6 cases,type IIb in 14 cases,type III in 11 cases. All the cases were fresh unilateral intertrochanteric fracture first time and the operation were delayed more than 72 h. The exclusion criteria included other associated fractures,pre-exist anaemia, anticoagulation and gastrointestinal bleeding and preoperative blood transfusion.All the patients got blood routine examination was performed in all the patients on the day of injured day and the following 1 day, 2 days and 3 days, and recorded red blood cells(RBC), hemoglobin(Hb) and hematocrit(Hct).According to Gross equation,the preoperative hidden blood loss can be calculated by patients’ height,weight and the difference of Hct from two different times.Hidden blood loss= red blood cell volume loss/Hct0; Red blood cell volume loss = patient blood volume(PBV) ×(Hct0-Hct3), PBV=k1×height(m)3+k2×weight(kg)+k3, Male kl=0.3669, k2=0.03219, k3=0.6041;Female kl=0.356,k2=0.03308,k3=0.1833. Post injured three consecutive days of RBC, Hb and Hct of intertrochanteric fractures were collected for statistics analysis. SPSS 1 3.0 statistics software was used for the value of Hct, RBC and Hb on the injured day and the post-injured third day of male and female group t-test respectively. And hidden blood loss calculated for each group.Results:1 The value of RBC in the injured day, post-injury 1 day, post-injury 2 days, post-injury 3 days, in male group was 4.00±0.51, 3.49±0.55, 3.40±0.48, 3.23±0.35, in female group was 3.49±0.52, 3.13±0.45, 3.01±0.49, 2.85±0.46. RBC of male and female was decreased continuously following the injury and reached the lowest point at the 3 post-injury days. The value of RBC on the injured day compared to that on post-injury 3 days decreased 0.77±0.51 in male(P<0.05), and0.63±0.24 in female(P<0.05). The difference was statistically significant.2 The value of Hb in the injured day, post-injury 1 day, post-injury 2 days, post-injury 3 days in male group was 123.72±10.85g/L, 113±12.61 g/L, 107.63±15.47 g/L, 102.47±13.31 g/L, in female group was 108.32±14.09 g/L, 97.85±12.57 g/L, 94.09±14.30 g/L, 91.22±14.81 g/L. Hb of male and female was decreased continuously following the injury and reach the lowest point at the 3 post-injury days. The value of Hb on the injured day compared to that on post-injury 3 days decreased 21.25±11.68g/L in male(P<0.01) and 17.09±4.66g/L in female(P<0.01). The difference was statistically significant.3 The value of Hct in the injured day, post-injury 1 day, post-injury 2 days, post-injury 3days, in male group was 35.57±3.14%, 33.34±3.60%, 31.45±4.58%, 29.54±3.27%, in female group was 31.69±3.99%, 28.65±3.43%, 27.43±3.95%, 25.91±4.13%, Hct of male and female was decreased continuously following the injury and reached the lowest point at the 3 post-injury day. The value of Hct on the injured day compared to that on post-injury 3 days decreased 6.03±2.71% in male(P<0.01) and 5.77±1.56% in female(P<0.01). The difference was statistically significant.4 The mean preoperative blood loss of 37 elderly patients with intertrochanteric fracture in post-injury 1 day, post-injury 2 days, post-injury 3days was 292.29 m L, 488.31 and 729.76 m L calculated by Gross equation respectively. The average RBC was decreased 0.68×1012, Hb was decreased 19.17g/L, and Hct was decreased 5.84%.The average preoperative hidden blood loss was 755.80 m L in male and 690.26 m L in female groups.Conclusion: The hidden blood loss of elderly patients with femoral intertrochanteric fracture was significant from the injured day to the following post-injured 3 days,which the clinicians tend to ignore. The study highlights that even the Hb of the patients was normal on the day of admission at beginning,the re-examining Hb pre-operation regularly is necessary to identify whether the patient suffered anemia and correct it in time, and then reduce the perioperative risk. |
