探讨氨甲环酸在老年股骨转子间骨折围手术期应用安全性及有效性分析

目的探讨氨甲环酸(tranexamic acid,TXA)降低老年股骨转子间骨折围术期失血量的安全性及有效性。方法按照随机数字表法将2016年3月至2018年1月收治的200例老年股骨转子间骨折患者分为A、B、C、D组,每组50例。A组为对照组,共50例,其中男22例,女28例,平均年龄(77.74±6.53)岁,骨折按AO/OTA分型:A型17例,B型19例,C型14例。B组术前30 min静滴TXA 1 g,共50例,其中男27例,女23例,平均年龄(79.25±6.55)岁,骨折按AO/OTA分型:A型19例,B型15例,C型16例。C组术毕在骨折断端筋膜处注射TXA 1 g,共50例,其中男19例,女31例,平均年龄(74.35±5.97)岁,骨折按AO/OTA分型:A型13例,B型22例,C型15例。D组术前30 min静滴TXA 1 g,术毕在骨折断端筋膜处注射TXA 1 g,共50例,其中男24例,女26例,平均年龄(76.62±6.21)岁,骨折按AO/OTA分型:A型21例,B型18例,C型11例。记录各组总失血量、隐形失血量;术后1天和3天血红蛋白、红细胞压积、D-二聚体及纤维蛋白原、并发症发生率及输血率。结果B组(815.33±278.79)ml、C组(935.15±207.54)ml、D组(795.56±243.18)ml的总失血量低于A组(1096.88±223.79)ml,各组相比差异有统计学意义(P=0.024);B组(501.95±260.72)ml、C组(679.22±215.64)ml、D组(456.18±215.64)ml的隐性失血量低于A组(832.60±253.41)ml,各组相比差异有统计学意义(P=0.005);术后1天B组(110.84±11.73)g/L、C组(105.26±13.70)g/L、D组(109.40±13.81)g/L的血红蛋白值均高于A组(103.68±10.85)g/L,各组相比差异有统计学意义(P=0.014)。与C组相比,B组与D组在降低围术期总失血量和隐性失血量更有效果。术后3天四组的血红蛋白、红细胞压积、D-二聚体、纤维蛋白原、术后下肢深静脉血栓发生率及切口并发症发生率相比差异无统计学意义(P>0.05)。所有患者均无肺栓塞发生。结论老年转子间骨折患者围术期使用TXA均可降低围术期总失血量和隐性失血量,对术后康复有一定的积极作用,且不增加深静脉血栓发生率,静脉或联合应用效果更优。

Clinical research of tranexamic acid in reducing perioperative blood loss of elderly patients with intertrochanteric fracture

Objective To investigate the safety and effectiveness of tranexamic acid(TXA)in reducing perioperative blood loss of elderly femoral intertrochanteric fractures.Methods According to the random number table method,200 elderly patients with femoral intertrochanteric fractures,admitted from March 2016 to January 2018,were divided into Group A,B,C and D,with 50 cases in each group.Group A:control group;22 males and 28 females;an average age of(77.74±6.53)years;17 cases of type A,19 cases of type B,and 14 cases of type C according to AO/OTA classification.Group B:TXA 1 g was administered intravenously 30 minutes before surgery;27 males and 23 females;an average age of(79.25±6.55)years;19 patients of type A,15 patients of type B,and 16 patients of type C according to AO/OTA classification.Group C:TXA 1 g was injected into the fractured fascia at the end of the operation;19 males and 31 females;an average age of(74.35±5.97)years;13 patients of type A,22 patients of type B,and 15 patients of type C according to AO/OTA classification.Group D:TXA 1 g was intravenously administered 30 minutes before surgery;TXA 1 g was injected into the fractured fascia at the end of the operation;24 males and 26 females;an average age of(76.62±6.21)years;21 patients of type A,18 patients of type B,and 11 patients of type C according to AO/OTA classification.Total blood loss and invisible blood loss were recorded in each group.Hemoglobin,hematocrit,D-dimer,fibrinogen,incidence of complications,and blood transfusion rate at 1 and 3 days after operation were analyzed.Results The total blood loss of Group B(815.33±278.79)ml,Group C(935.15±207.54)ml,and Group D(795.56±243.18)ml were lower than that of Group A(1096.88±223.79)ml with statistically significant differences(P=0.024);the hidden blood loss of Group B(501.95±260.72)ml,Group C(679.22±215.64)ml,and Group D(456.18±215.64)ml were lower than that of Group A(832.60±253.41)ml with statistically significant differences(P=0.005);the hemoglobin values 1 day after surgery of Group B(110.84±11.73)g/L,Group C(105.26±13.70)g/L,and Group D(109.40±13.81)g/L were higher than that of Group A(103.68±10.85)g/L with statistically significant differences(P=0.014).Compared with Group C,Group B and Group D were more effective in reducing total blood loss and hidden blood loss perioperatively.There were no significant differences in hemoglobin,hematocrit,D-dimer,fibrinogen,postoperative DVT,and incision complications among the 4 groups 3 days after surgery(P>0.05).No pulmonary embolism occurred in all patients.Conclusions Tranexamic acid can reduce the total and hidden blood loss perioperatively and further promote postoperative rehabilitation for the elderly patients with intertrochanteric fractures.It will not increase the incidence of deep vein thrombosis with favorable effects by intravenous or combined application.