林吉生,吕芳硕,李锦军,费琦

• 1:首都医科大学附属北京友谊医院骨科

摘要(Abstract)：

目的：分析单侧双通道内镜（UBE）手术治疗腰椎退行性疾病围手术期隐性失血的危险因素。方法：回顾性分析2020年12月至2022年12月于首都医科大学附属北京友谊医院接受UBE手术治疗的81例单节段腰椎退行性疾病患者的临床资料。其中人口统计学资料包括性别、年龄、身高、体重、体重指数（BMI）、病史、吸烟史、饮酒史；实验室检查资料包括术前与术后第1日血红蛋白（Hb）、白蛋白（Alb）、红细胞压积（HCT）、血小板计数及术前凝血功能指标、术前生化指标；影像学资料包括目标节段皮下软组织厚度、皮下脂肪厚度、椎旁肌肉厚度、椎旁肌肉厚度与皮下软组织厚度比；手术资料包括诊断、美国麻醉医师协会（ASA）分级、手术时间、手术节段、是否行椎间盘切除、单侧/双侧减压、术中出血量、术后第1日引流量。计算围手术期总失血量及隐性失血量，采用单因素分析和Spearman相关分析探讨UBE手术隐性失血的相关危险因素，应用多元线性回归分析进一步分析影响UBE手术隐性失血的独立危险因素。结果：本组患者总失血量为516.5(453.1,598.8)mL，显性失血量为58.0(40.1,72.3)mL，隐性失血量为342.6(285.6,412.4)mL。单因素分析结果显示，性别、是否行椎间盘切除与UBE手术围手术期隐性失血有关联（P均<0.05）；相关分析结果显示，身高、手术时间、术前HCT及Hb、Alb、D-二聚体、甘油三脂（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）水平与UBE手术围手术期隐性失血有相关性（P均<0.05）。进一步多元线性回归分析结果显示，术前Alb水平、椎间盘切除和手术时间是UBE手术围手术期隐性失血的独立危险因素（P均<0.05）。结论：UBE手术治疗腰椎退行性疾病围手术期存在明显的隐性失血。术前Alb水平、椎间盘切除和手术时间可能是UBE手术围手术期隐性失血的独立危险因素。

关键词(KeyWords)： 单侧双通道内镜手术;腰椎退行性疾病;隐性失血;危险因素

Abstract:

Keywords:

基金项目(Foundation): 通州区科技计划项目（KJ2024CX053）

作者(Author): 林吉生,吕芳硕,李锦军,费琦

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