대퇴골 경부 골절에 대한 양극성 인공 고관절 반치환술에서의 실혈량: 위험 인자 분석
Perioperative Blood Loss in Bipolar Hemiarthroplasty for Femoral Neck Fracture: Analysis of Risk Factors
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목적: 고관절 대퇴 경부 골절로 인한 양극성 반 인공 관절 치환술 후 보이지 않는 실혈을 포함한 실질적인 총 실혈량을 계산하여 측정된 실혈량과의 차이를 알아보고 위험 인자가 술 후 실혈량에 미치는 영향을 알아보고자 한다. 대상 및 방법: 2004년부터 2010년까지 본원에서 시행한 대퇴 경부 골절 후 양극성 반 인공관절 치환술을 시행한 환자 356예를 대상으로 하였고 총 실혈량의 계산은 Mercuriali와 Brecher에 의한 공식을 사용하였으며 실혈량에 미치는 위험 인자로 성별, body mass index (BMI), 마취 방법, 심혈관 질환이나 뇌혈관 질환 유무, 술전 빈혈 여부, American Society of Anesthesiologists (ASA) 점수, 시멘트 사용 여부, 항혈전제 사용 여부를 비교 분석하였다. 결과: 계산된 총 실혈량은 1,408±72 ml이고 측정된 실혈량은 980±102 ml로 유의한 차이를 보였고 실혈량과 관련된 위험 인자 중 심혈관 질환이 있을 경우 1,526±369 ml, 전신 마취 시행 시 1,588±279 ml, 비만이 있는 경우 1,645±920 ml, 항혈전제 사용 시 1,605±439 ml로 증가된 결과를 보였다. 결론: 고관절 대퇴 경부 골절 후 양극성 반 인공 관절 치환술시 발생된 총실혈량은 측정된 실혈량에 비해 많은 많은 양이 측정되었으며 수술대상 환자 중 심혈관 질환 및 항혈전제 복용자, 비만 환자, 전신 마취 시에는 수술 시 출혈량을 줄이기 위한 세심한 노력이 필요할 것으로 사료된다.
Abstract
Purpose: We compared visible blood loss and calculated blood loss after bipolar hemiarthroplasty in femoral neck fracture, and evaluated correlation between blood loss and its risk factors. Materials and Methods: A total of 356 patients who underwent bipolar hemiarthroplasty in femoral neck fracture between 2004 and 2010 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score, use of cement, and use of antithrombotic agents. Results: Total calculated blood loss(1,408±72 ml) differed significantly from visible blood loss(980±102 ml). In addition, calculated blood loss differed between risk factors(1,526±369 ml in cardiovascular disease, 1,588±279 ml in general anesthesia, 1,645±920 ml in obesity, and 1,605±439 ml in use of antithrombotic agents). Conclusion: Total calculated blood loss was much greater than visible blood loss. Patients with risk factors such as cardiovascular disease, obesity, use of antithrombotic agents, and general anesthesia should be treated with care in order to reduce blood loss.
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