老年髋部骨折术后低钙血症与隐性失血量的相关性研究

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Abstract

Objective To investigate the effect of postoperative hypocalcemia on the postoperative occult blood loss and blood transfusion ratio in elderly patients with hip fractures.Methods We collected elderly patients with hip fractures who were transferred to ICU after surgery at Beijing Jishuitan Hospital from January 2022 to January 2023.A total of 148 patients were included in the study，including 51 males and 97 females.The patient age ranged from 67 to 97 years，with an average age of (84.3±8.1) years.We corrected blood calcium concentration based on albumin.Blood calcium below 2.11 mmol/L was defined as hypocalcemia.50% of the patients transferred to ICU (148 cases) developed hypocalcemia (74 cases).Blood samples (hemoglobin and hematocrit) were collected immediately after the patient was transfered to the ICU after surgery，and blood transfusion volume during and two days after surgery was recorded.According to the calculation formula，the patient’s implicit blood loss within two days after surgery was calculated.Single factor and multiple factor linear regression were used to further analyze risk factors.Results A total of 148 patients were included.There was no significant difference in hemoglobin and hematocrit between the hypocalcemia group and the normal group.The blood transfusion ratio in the low calcium group (87.8%) was significantly higher than that in the normal group (51.4%)，P＜0.001.The occult blood loss in the low calcium group was 523.8 (159.6，993.8) mL，which was significantly higher than the 357.3(80.7，594.8) mL in the normal group(P＝0.005).The blood transfusion volume in the normal group was 200 mL(0，400).The blood transfusion volume in the hypocalcemia group was 400 mL(400，400) mL，which was significantly higher than that in the normal group(P＜0.001).The ICU hospitalization time in the low calcium group was significantly longer than that in the normal group(P＝0.043).Analysis of risk factors related to postoperative occult blood loss showed that the independent risk factors associated with increased postoperative blood loss were fracture type(intertrochanteric fracture of the femur)，blood transfusion volume，and hypocalcemia(P＜0.05).Conclusion Postoperative patients with hypocalcemia have significantly increased occult blood loss，higher blood transfusion rates and volumes，and significantly prolonged ICU hospitalization.Fracture type(intertrochanteric fracture) and hypocalcemia are independent risk factors for increased postoperative blood loss.The results remind clinicians to pay attention to postoperative hypocalcemia，pay attention to intraoperative calcium supplementation，and optimize perioperative management for elderly patients with hip fracture.

Key words： elderly hip fracture hypocalcemia hidden blood loss blood transfusion

Corresponding Authors: Zhou Ning

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	Bai Ying
	Yu Miaomiao
	Jin Lixian
	Li Zhimin
	Li Huajie
	Kong Yueyue
	Zhou Ning

Cite this article:

Bai Ying,Yu Miaomiao,Jin Lixian, et al. Correlation between Postoperative Hypocalcemia and Postoperative Blood Loss in Elderly Patients With Hip Fracture[J]. sygkzz, 2023, 29(7): 609-.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2023/V29/I7/609

［1］Si L，Winzenberg TM，Jiang Q，et al.Projection of osteoporosis-related fractures and costs in China：2010-2050［J］.Osteoporosis Int，2015，26(7)：1929-1937.
［2］Wu JZ，Liu PC，Ge W，et al.A prospective study about the preoperative total blood loss in older people with hip fracture［J］.Clin Interv Aging，2016，31(11)：1539-1543.
［3］Luo X，He S，Li Z，et al.Quantifcation and infuencing factors of perioperative hidden blood loss during intramedullary fxation for intertrochanteric fractures in the elderly［J］.Arch Orthop Trauma Surg，2020，140(10)：1339-1348.
［4］Yombi JC，Putineanu DC，Cornu O，et al.Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients［J］.Bone Joint J，2019，101(9)：1122-1128.
［5］Fenwick A，Pfann M，Mayr J，et al.Anticoagulants and fracture morphology have a significant influence on total blood loss after proximal femur fractures［J］.Eur J Trauma Emerg Surg，2023，49(1)：173-179.
［6］Wray J，Bridwell R，Schauer S，et al.The diamond of death：Hypocalcemia in trauma and resuscitation［J］.Am J Emerg Med，2021(41)：104-109.
［7］De Robertis E，Kozek-Langenecker SA，Tufano R，et al.Coagulopathy induced by acidosis，hypothermia and hypocalcaemia in severe bleeding［J］.Minerva Anestesiol，2015，81(1)：65-75.
［8］Epstein D，Solomon N，Korytny A，et al.Association between ionised calcium and severity of postpartum haemorrhage：A retrospective cohort study［J］.Br J Anaesth，2021，126(5)：1022-1028.
［9］Pepe J，Colangelo L，Biamonte F，et al.Diagnosis and management of hypocalcemia［J］.Endocrine，2020，69(3)：485-495.
［10］Nadler S，Hidalgo J，Bloch T.Prediction of blood volume in normal human adults［J］.Surgery，1962，51(2)：224-232.
［11］Gross J.Estimating allowable blood loss：Corrected for dilution［J］.Anesthesiology，1983，58(3)：277-280.
［12］Cooper MS，Gittoes NJ.Diagnosis and management of hypocalcaemia［J］.BMJ，2008，336(7656)：1298-1302.
［13］Lee K，Lee I.Preoperative laboratory testing in elderly patients［J］.Curr Opin Anaesthesiol，2021，34(4)：409-414.
［14］Vasudeva M，Mathew J，Groombridge C，et al.Hypocalcemia in trauma patients：A systematic review［J］.J Trauma Acute Care Surg，2021，90(2)：396-402.
［15］Gai P，Sun H，Sui L，et al.Hypocalcaemia after total knee arthroplasty and its clinical signifcance［J］.Anticancer Res，2016，36(3)：1309-1311.
［16］Freund Y，Avrahami R，Korytny A，et al.Association between ionised calcium and severity of postpartum haemorrhage：A retrospective cohort study［J］.Br J Anaesth，2021，126(5)：1022-1028.
［17］Sallinen H，Wu TY，Meretoja A，et al.Efect of baseline hypocalcaemia on volume of intracerebral haemorrhage in patients presenting within 72 hours from symptom onset［J］.J Neurol Sci，2019(403)：24-29.
［18］Delcourt C，Huang Y，Arima H，et al.Hematoma growth and outcomes in intracerebral hemorrhage：The INTERACT1 study［J］.Neurology，2012，79(4)：314-319.
［19］Ho KM，Yip CB.Concentration-dependent efect of hypocalcaemia on invitro clot strength in patients at risk of bleeding：A retrospective cohort study［J］.Transfus Med，2016，26(1)：57-62.
［20］Wang Z，Chen X，Chen Y，et al.Association between admission serum calcium and hemoglobin in older patients with hip fracture：A cross sectional study［J］.Eur Geriatr Med，2022，13(2)：445-452.
［21］北京医学会输血医学分会，北京医师协会输血专业专家委员会，汪德清，等.患者血液管理—术前贫血诊疗专家共识［J］.中华医学杂志，2018，30(98)：2386-2392.
［22］Stacey J，Bush C，DiPasquale T.The hidden blood loss in proximal femur fractures is sizeable and Signifcant［J］.J Clin Orthop Trauma，2021(16)：239-243.
［23］Lin PH，Chien JT，Hung JP，etal.Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period：A retrospective case control study［J］.BMC Musculoskelet Disord，2020，21(1)：244.
［24］刘刚，杨明辉，张京，等.北京地区老年髋部骨折的流行病学分布特点：多中心2 071例患者分析［J］.中华创伤骨科杂志，2022，24(9)：759-765.
［25］危杰，王军，高明，等.老年髋部骨折围手术期失血量的分析［J］.中华创伤骨科杂志，2015，17(2)：104-107.
［26］Puckeridge G，Terblanche M，Wallis M，et al.Blood management in hip fractures；are we leaving it too late? A retrospective observational study［J］.BMC Geriatr，2019，19(1)：79.

[1]	. [J]. sygkzz, 2023, 29(6): 572-.