间歇冷疗对于胸腰椎骨折术后隐性失血的影响

Effect of intermittent cold therapy on occult blood loss following open reduction and internal fixation of thoracolumbar frac⁃ tures

摘要:

[目的] 探讨间歇冷疗对于胸腰椎骨折术后隐性失血的影响。[方法] 2021 年 1 月—2022 年 11 月本科连续收治的 66 例急性胸腰椎骨折行切开复位内固定的患者纳入本研究，采用随机数表法将患者分两组，其中冷疗组 33 例，术后 6~8 h 局部间歇冷敷；常规组 33 例，未行局部冷敷。比较两组围手术期临床与检验资料。[结果] 两组患者均顺利完成手术，均无血管、神经损伤，或术中大出血等严重并发症。两组手术时间、术中失血量及术后引流量的差异均无统计学意义 (P＞0.05)。但是，冷疗组的总失血量 [(608.5±386.2)ml vs (879.2±368.0)ml, P=0.008] 和隐性失血量 [(334.0±355.4)ml vs (544.3±283.1)ml, P=0.010] 均显著少于常规组。随术后时间推移，两组切口疼痛 VAS 评分均显著减少(P＜0.05)；相应时间点，两组间切口疼痛 VAS 评分的差异均无统计学意义 (P＞0.05)。检验方面，术前两组患者的 Hb 和 HCT 的差异均无统计学意义 (P＞0.05)；但是，术后 3、 7 d 冷疗组的 Hb [(112.9±13.2)g/L vs (103.7±15.1)g/L, P=0.015; (117.7±12.7)g/L vs (106.3±12.3)g/L, P=0.001] 和 Hct [(34.8±3.9)% vs (32.7±4.0)%, P=0.039; (36.0±3.9)% vs (33.3±3.4)%, P=0.005] 均显著高于常规组。[结论] 局部间歇冷疗显著减少胸腰椎骨折术后总失血量、隐性失血量、Hb 和 Hct 的下降。可能有利于患者术后早期康复。

Abstract:

[Objective] To explore the effect of intermittent cold therapy on occult blood loss after open reduction and internal fixation (ORIF) of thoracolumbar fractures. [Methods] A total of 66 consecutive patients who were undergoing ORIF for acute thoracolumbar frac- tures in our department from January 2021 to November 2022 were included in this study. The patients were divided into two groups by ran- dom number table method, among them 33 patients in cold therapy (CT) group were treated with local intermittent cold compress 6 to 48 hours after surgery, while the other 33 patients in the routine group (RT) not received local cold compress anymore. The perioperative clini- cal and laboratory data were compared between the two groups. [Results] All the patients in both groups had OTIF performed smoothly with- out serious complications such as neurovascular injury or intraoperative massive bleeding. Although there were no significant differences in operation time, intraoperative blood loss and postoperative drainage volume between the two groups (P＜0.05), the CT group proved signifi- cantly superior to the RT group in terms of total blood loss [(608.5±386.2)ml vs (879.2±368.0)ml, P=0.008] and occult blood loss [(334.0± 355.4)ml vs (544.3±283.1)ml, P=0.010]. The VAS score for incision pain decreased significantly in both groups over time postoperatively (P＜0.05), which was not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding laboratory tests, there was no statistical significance in Hb and HCT between the two groups before surgery (P＜0.05), however, the CT group was significant- ly superior to the RT group in terms of Hb [(112.9±13.2)g/L vs (103.7±15.1)g/L, P=0.015; (117.7±12.7)g/L vs (106.3±12.3)g/L, P=0.001] and Hct [(34.8±3.9)% vs (32.7±4.0)%, P=0.039; (36.0±3.9)% vs (33.3±3.4)%, P=0.005] 3 days and 7 days postoperatively. [Conclusion] Local intermittent cold therapy does significantly reduce total blood loss, occult blood loss, and declines of Hb and Hct following ORIF of thoracolumbar fractures, which might be beneficial to the early postoperative recovery.