Objective: To compare the intraoperative blood loss, postoperative drainage and hidden blood loss (HBL) in lumbar posterior lumbar interbody fusion (PLIF) in patients with and without rheumatoid arthritis (RA), and analyze the relevant factors of HBL in RA patients. Methods: Fifty patients with RA (RA group) and 73 patients without RA (NRA group) treated in the Heze Municipal Hospital from January 2014 to April 2019 were enrolled in this study. The basic information, RA information, operation and related blood loss indicators in the two groups were compared. The intraoperative blood loss, postoperative drainage and HBL were the main results. The secondary results were operation time, preoperative and postoperative hematocrit (Hct) and hemoglobin (Hb) and their variation values, cases of anemia before and after surgery, number of new anemia after surgery, autologous blood and allogeneic blood transfusion, etc. The correlation factors of HBL in RA group were analyzed by multi-linear regression model. Results: There were 9 males and 41 females with a mean age of (62±7) years in RA group; and 11 males and 62 females with a mean age of (64±9) years in NRA group. The course of disease in RA group was (14.4±11.2) years, the most common anti-rheumatism drug (DMARDs) were single-drug and combined oral. There was no significant differences between the two groups in the number of vertebral bow screws and intervertebral fusion device. The incidence of surgical complications was comparable between the two groups. Differences between the two groups in total blood loss (TBL), intraoperative blood loss, and postoperative drainage were not statistically significant ((693±315) ml vs (630±365) ml, (454±373) ml vs (414±375) ml and (653±376) ml vs (675±400) ml, t=1.072, 0.388, -0.189, all P>0.05), while the HBL and the percentage of HBL in TBL were lower in the NRA group (t=6.157, 2.965, both P<0.05). According to the layered analysis of the number of surgical segments, the proportion of HBL and the HBL percentage of TBL in the NRA group for the long section (≥3 segments) surgery were better than those in the RA group. The Hct changing value was larger in the RA group than that in the NRA group (P=0.031). However, the difference of Hb reduction between the two groups was not statistically significant (P>0.05). There was no significant difference in anemia and exacerbation of anemia after surgery, allogeneic blood transfusion and the operation duration between the two groups (all P>0.05). A multi-linear regression analysis of HBL showed that higher RA’s Steinbrocker grading, did not take DMARDS, Hb changes and infusion of allogeneic blood were independently correlated to HBL (β=0.363, -0.272, 0.210, 1.204, all P<0.05). Conclusions: There is no difference in TBL, intraoperative blood loss, postoperative drainage and operation duration between the RA and NRA group, while HBL and the proportion of HBL in the TBL are higher in the RA group. The RA group has higher Steinbrocker rating, no DMRDs and more Hb changes.

目的： 比较合并与不合并类风湿性关节炎（RA）的腰椎滑脱症患者腰椎后路减压融合术（PLIF）术中出血量、术后引流量及隐性失血（HBL），探讨RA患者术中HBL的相关因素。 方法： 回顾性纳入2014年1月至2019年4月在菏泽市立医院接受治疗的50例合并RA的腰椎滑脱症患者（RA组），同时期筛选73例未合并RA的患者（NRA组）。分析比较两组基本信息、RA信息、手术情况以及出血量相关指标。以术中出血量、术后引流量和HBL作为主要结果；手术时间、术前术后血细胞比容（Hct）和血红蛋白（Hb）及其变化值、手术前后贫血数量、术后新发贫血数量、自体血和异体血输注量等作为次要结果。应用多元线性回归模型分析RA组HBL的相关因素。 结果： RA组男9例，女41例，年龄（62±7）岁；NRA组男11例，女62例，年龄（64±9）岁。RA组病程为（14.4±11.2）年，其中单药或联合口服改变病情抗风湿药（DMARDs）者最常见，两组在椎弓根螺钉数和椎间融合器置入上差异均无统计学意义，围手术期并发症发生率相当。两组在总失血量（TBL）、术中出血量和术后引流量等差异均无统计学意义［（693±315） ml比（630±365） ml、（454±373） ml比（414±375） ml和（653±376） ml比（675±400） ml，t=1.072、0.388、-0.189，均P>0.05］，而HBL及HBL所占TBL比例在NRA组中更低（t=6.157、2.965，均P<0.05）。根据手术节段数进行分层分析，长节段（≥3节段）手术中NRA组中HBL和HBL所占TBL比例均优于RA组。次要结果对比Hct改变值在NRA组小于RA组（P=0.031），但两组Hb减小值差异无统计学意义（P>0.05）；术后两组新发贫血以及贫血加重差异无统计学意义，异体血输注和手术时间差异也无统计学意义（均P>0.05）。RA的Steinbrocker级别高、未服用DMARDS、Hb变化和输注异体血为HBL的独立相关因素（β=0.363、-0.272、0.210、1.204，均P<0.05）。 结论： RA组和NRA组在TBL、术中出血、术后引流和手术时间上无差异，而HBL以及HBL所占TBL比例在RA组高于NRA组；RA组的Steinbrocker分级高、未服用DMARDs、Hb改变较多。.