氨甲环酸不同用药途径对女性股骨颈骨折全髋关节置换术失血的疗效分析

目的：研究氨甲环酸不同应用方式治疗老年女性股骨颈骨折行全髋关节置换术围手术期失血的疗效。方法：将2015年12月至2018年1月老年女性股骨颈骨折行全髋关节置换术患者77例分成4组：A组（静脉用药组）21例，年龄（77.10±7.02）岁，于手术切皮前5 min使用15 mg/kg氨甲环酸静脉滴注并且术中生理盐水灌注关节腔；B组（局部用药组）18例，年龄（73.83±6.56）岁，于手术切皮前5 min生理盐水静脉滴注并且术中使用总剂量为3 g的氨甲环酸灌注关节腔；C组（联合用药组）19例，年龄（74.26±6.04）岁，术前使用15 mg/kg氨甲环酸静滴并且术中使用总剂量为1.5 g的氨甲环酸灌注关节腔；D组（对照研究组）19例，年龄（76.69±9.27）岁，于手术切皮前5 min生理盐水静脉滴注并且术中生理盐水灌注关节腔。记录术后伤口引流量、血红蛋白变化，根据身高体重和手术前后的红细胞压积（HCT）计算所有患者的总失血量等。结果：A组术后引流量为（111.91±35.02） ml，血红蛋白改变量为（26.86±12.99） g/L，总失血量为（628.6±306.78） ml；B组术后引流量为（108.89±36.61） ml，血红蛋白改变量为（26.28±8.59） g/L，总失血量为（584.41±250.86） ml；C组术后引流量为（102.63±47.36） ml，血红蛋白改变量为（26.89±12.47） g/L，总失血量为（634.78±384.89） ml；D组术后引流量为（107.37±40.53） ml，血红蛋白改变量为（40.95±12.48） g/L，总失血量为（1 005.24±483.37） ml。4组术后引流量比较差异无统计学意义（P>0.05）；A、B、C组术后血红蛋白改变量、总失血量少于对照组D组（P<0.05），但是3组组间比较差异无统计学意义（P>0.05）。结论：应用氨甲环酸能有效减少老年女性股骨颈骨折行全髋关节置换术围手术期失血，但是最佳给药方式及给药剂量需要进一步的研究。

Preliminary analysis of the effect of different administration routes of tranexamic acid on blood loss after total hip arthroplasty for female femur neck fractures

Objective: To study curative effect of different administration routes of tranexamic acid (TXA) on blood loss of elderly female patients with femoral neck fracture in total hip arthroplasty.Methods: From December 2015 to January 2018,77 elderly women with femoral neck fractures undergoing total hip replacement were divided into four groups:group A,group B,group C,and group D. The group A (intravenous medication group) included 21 patients with an average age of (77.10±7.02) years old. The patients in group A received 15 mg/kg TXA intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The group B(local medication group) included 18 cases,with an average age of (73.83±6.56) years old. The patients in group B received saline intravenously 5 minutes before skin incision and intraoperative infusion of 3 g TXA into the joint cavity. The group C (combined medication group) included 19 cases,with an average age of (74.26±6.04) year old. The patients in group C received 15 mg/kg TXA intravenously before operation and intraoperative infusion of 1.5 g TXA into the joint cavity. The group D (control group) included 19 cases,with an average age of (76.69±9.27) years old. The patients in group D received saline intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The postoperative wound drainage volume,hemoglobin value,and the total blood loss calculated according to the height and weight and the hematocrit (HCT) before and after operation were observed and compared.Results: In group A,the postoperative drainage was(111.91±35.02)ml;the change of hemoglobin was(26.86±12.99) g/L;and total blood loss was(628.60±306.78) ml. In group B,postoperative drainage was(108.89±36.61) ml;change of hemoglobin was(26.28±8.59) g/L;and the total blood loss was (584.41±250.86) ml. In group C,postoperative drainage was(102.63±47.36) ml;change of hemoglobin was (26.89±12.47) g/L;and total blood loss was(634.78±384.89) ml. In group D,postoperative drainage was(107.37±40.53) ml;change of hemoglobin was(40.95±12.48) g/L;and total blood loss was(1 005.24±483.37) ml. There were no significant differences among 4 groups in postoperative drainage volume (P>0.05). The hemoglobin and total blood loss in group A,B,and C were less than those in the group D(P<0.05),however,there were no significant differences among three groups(P>0.05).Conclusion: Application of TXA can effectively reduce blood loss during perioperative period of total hip arthroplasty for elderly women with femoral neck fracture. The best administration route and dosage should be further studied.