Analysis On The Relevant Factors Of Hidden Blood Loss In The Perioperative Period Of Thoracolumbar Burst Fracture Accompanied With Neurological Deficiency

Objective: To analyze the relevant factors of hidden blood loss(HBL)in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency.Methods: The clinical data of 85 cases of the patients with thoracolumbar burst fracture and neurological deficiency received spinal surgery treatment in our hospital from September,2016 to January,2019 were analyzed.The patients' data including age,gender,ethnic group,hypertension,diabetes,coronary heart disease,history of smoking and drinking,free fatty acid(Total cholesterol,triglyceride),time of operation,length of surgical incision,the amount of crystalloid solution during operation,the amount of colloidal solution during operation,autologuous blood injection,homologous blood transfusion,postoperative recovery rate of vertebral height,time window of surgical treatment(<48 hours,?48 hours),the segment of fractured vertebra and the segment of operative fixation were recorded.Gross was adopted to calculate the volume of hidden blood loss.Multivariate logistic regression analysis was used to further discuss the independent risk factors after the risk factors with statistical significance analyzed by single-factor logistic regression.Decision tree model of SPSS 24.0 statistics software was employed to hierarchically predict and analyze the independent risk factors with continuous variable,and GraphPad Prism 8.0 was applied to verify by drawing ROC area under curve(AUC).Results: There were 66 males and 19 females with an average age of(40.75±12.42)years in the total 85 cases of the patients with thoracolumbar burst fracture and neurological deficiency.The estimated total blood loss volume was(1030.84±115.45)ml.The volume of hidden blood loss was(484.57±98.38)ml.The volume of hidden blood loss accounted for 47.05% of the total blood loss volume in theory.There were 34 cases of positive hidden blood loss(>470ml),making up to 40.0%.The results of single-factor and multivariate logistic regression analysis were shown as follows: Age,slightly-highcholesterol and triglyceride,extended surgical incision and surgical time window <48h,and smoking history were the independent risk factors of positive hidden blood loss during the perioperative period.According to the decision tree model analysis of SPSS 24.0statistics,Age>48,Cholesterol>5.76mmol/l,Triglyceride>1.63mmol/l,combined smoking history is high risk factor of positive hidden blood loss.The ROC area under the curve(AUC)was drawn to verify that when the age>48,the AUC,sensibility and specificity were 0.814,66.0%,88.4% respectively.It has a certain accuracy,but the accuracy of cholesterol>5.76mmol/l,Triglyceride>1.63mmol/l is low.Conclusion: Age>48,slightly-high cholesterol and triglyceride,extended surgical incision,surgical time window<48h,combined with smoking history turn out to be the high risk factors of positive hidden blood loss.