联合使用氨甲环酸对股骨颈骨折全髋关节置换术后失血量的影响

目的:探讨氨甲环酸静滴联合局部冲洗对老年股骨颈骨折行全髋关节置换术(THA)后失血量的影响。方法:将93例老年股骨颈骨折行THA术患者随机分为3组,每组31例,A组于术前15 min予1 g氨甲环酸静滴;B组于术中将2 g氨甲环酸注入500 ml生理盐水中,分别以250 ml脉冲冲洗髋臼和股骨髓腔;C组联合使用A组及B组的方法。检测术后总失血量、Hb最大下降值,术后72 h的Hb、APTT、D-二聚体等指标,观察血栓性并发症发生情况。结果:C组术后总失血量显著少于A组和B组(P<0.05);A、B、C组术后Hb最大下降值分别为(31.38±2.24)g/L、(37.51±4.21)g/L、(28.68±3.65)g/L,均有显著性差异(P<0.05);3组术后72 h Hb均有显著性差异(P<0.05),凝血指标均无显著性差异(P>0.05);3组术后均无深静脉血栓发生。结论:氨甲环酸静滴联合局部冲洗,能有效减少老年股骨颈骨折行THA术后失血量,降低术后Hb最大下降值,且不会增加血栓性并发症的发生。

Effect of combined use of tranexamic acid on blood loss after total hip arthroplasty for femoral neck fracture

Objective:To investigate the effect of combined use of intravenous drip of tranexamic acid(TXA)and local pulse irrigation with TXA on blood loss after total hip arthroplasty(THA)in elderly patients with femoral neck fracture.Methods:93 elderly patients with femoral neck fracture undergoing THA were randomly divided into three groups(n=31):group A received intravenous drip of 1 g of TXA 15 minutes before operation;group B received intravenous drip of 2 g of TXA into 500 ml of normal saline during operation,and then pulse irrigation of acetabulum and femoral marrow cavity with 250 ml of normal saline respectively;group C received the combined use of TXA in group A and group B.The postoperative total blood loss and the maximum decreased value of Hb were measured as well as Hb level,APTT and D-dimer concentration at 72 hours after operation.The thrombotic complications were observed.Results:The total blood loss of group C was significantly less than that of group A and group B(P<0.05);the maximum decrease of Hb in group A,B and group C was(31.38±2.24)g/L,(37.51±4.21)g/L,(28.68±3.65)g/L,respectively,which had significant differences(P<0.05);the Hb and coagulation indexes of three groups were significantly different(P<0.05)at 72 hours after operation;no deep venous thrombosis was found in three groups.Conclusion:The combined use of intravenous drip of TXA and local pulse irrigation with TXA can effectively decrease postoperative blood loss,reduce the maximum decreased value of Hb after operation and will not increase the incidence of thrombotic complications in elderly patients with femoral neck fracture undergoing THA.