Effect Of Perioperative Hidden Blood Loss On Postoperative Cognitive Function In Senile Femoral Intertrochanteric Fracture

Objective: To explore the relationship between perioperative hidden blood loss and postoperative cognitive dysfunction(POCD)in senile femoral intertrochanteric fracture.Methods:(1)From December 2018 to December 2019,98 patients with senile femoral intertrochanteric fracture were selected and treated by Proximal Femoral Nail Antirotation(PFNA)surgery in the Third Affiliated Hospital of Inner Mongolia Medical University.(2)Recorded the daily blood routine values of patients before and after surgery,and calculated the hidden blood loss;(3)By comparing the scores of Montreal cognitive assessment(Mo CA)before and after surgery,according to whether the patients have postoperative cognitive dysfunction,the patients were divided into postoperative cognitive dysfunction group and postoperative cognitive normal group.The differences of hidden blood loss,dominant blood loss,total blood loss and hemoglobin(Hb)and other indexes between the two groups were compared and statistically analyzed.(4)According to the hidden blood loss,the patients were divided into mild,moderate and severe hidden blood loss groups.The clinical data and Mo CA of the three groups were compared and statistically analyzed.Results:(1)Among 98 senile femoral intertrochanteric fractures,there were 21 patients with postoperative cognitive dysfunction,an average perioperative hidden blood loss of 1075.82±269.27 ml,including 5 patients with postoperative mild cognitive dysfunction,7 patients with postoperative moderate cognitive dysfunction,9 patients with postoperative severe cognitive dysfunction,and 77 patients with postoperative normal cognitive function,and an average perioperative hidden blood loss of 860.12±188.81ml;(2)The duration of the disease in the postoperative cognitive dysfunction group was longer than that in the postoperative cognitive normal group,which has significant difference(P < 0.05);(3)The postoperative cognitive dysfunction group had more hidden blood loss and total blood loss than the postoperative cognitive normal group,which has significant difference(P < 0.05),while there was no significant difference in dominant blood loss between the two groups(P > 0.05);(4)The postoperative cognitive dysfunction group had more hidden blood loss per day than the postoperative cognitive normal group,which has significant difference(P < 0.05);(5)Hb in postoperative cognitive dysfunction group was lower than that in postoperative cognitive normal group,which has significant difference(P < 0.05);(6)The total score of Mo CA and the scores of each item were in the group of severe hidden blood loss < moderate hidden blood loss < mild hidden blood loss;There were significant differences between the mild,moderate and severe recessive blood loss groups and the total score of Mo CA,the single score of executive ability and delayed memory(P < 0.05);(7)Perioperative hidden blood loss was negatively correlated with the total score of Mo CA(r=-0.208,P < 0.05);There was a negative correlation with the single score of executive ability(r=-0.312,P < 0.05);There was a negative correlation with the single score of delayed memory(r=-0.319,P < 0.05),and had no correlation with other single scores(P > 0.05).Conclusion:(1)During PFNA surgery in senile femoral intertrochanteric fracture,there is a negative correlation between perioperative hidden blood loss and cognitive function,that is,the more perioperative hidden blood loss,the worse the cognitive function of patients,and the higher the incidence and severity of POCD.(2)There is a negative correlation between the hidden blood loss and the total score of Mo CA,the single score of delayed memory and executive ability.That is,the more the hidden blood loss during perioperative period,the lower the total score of MoCA,the single score of delayed memory and executive ability.