局部联合静脉应用氨甲环酸对跟骨骨折手术治疗的疗效观察

目的 探讨局部联合静脉应用氨甲环酸（Tranexamic acid, TXA）对跟骨骨折手术治疗的疗效及安全性。方法 将2018年12月至2019年11月西安交通大学附属红会医院收治的38例（均为单侧）跟骨骨折患者随机分成两组，其中观察组20例、对照组18例。观察组患者：手术开始后静脉点滴TXA（15ml/kg）并在松止血带前5～10min局部灌注TXA（15ml/kg）；对照组患者在手术开始后以及松止血带前5～10min分别通过静脉点滴、局部灌注的方式应用（15ml/kg）的生理盐水。记录并对比两组患者的术中失血量、术后失血量、术后48h引流量、术前术后血液纤溶水平、血红蛋白指标、围手术期静脉血栓性疾病以及术后伤口并发症情况。 结果 38例患者中37例患者术后伤口一期愈合。观察组患者术中失血量（79.5012.98）ml，对照组（93.7210.72）ml;观察组患者术后失血量为（202.6536.75）ml，对照组（313.5054.59）ml；观察组患者术后第1天Hb（111.4510.52）g/L，对照组（104.0511.07）g/L；观察组患者术后48h引流量（189.9015.43）ml，对照组（252.2832.67）ml；观察组术后24hD二聚体（4.251.85）mg/L，对照组（6.012.59）mg/L；观察组术后24hFDP（3.311.09）mg/L，对照组（4.651.87）mg/L；观察组术后72hFDP（3.111.03）mg/L，对照组（4.221.71）mg/L；观察组术后伤口红肿渗出1例，对照组6例，以上指标两组相比观察组优于对照组，差异均有统计学意义（P〈0.05）。两组患者在术后下肢深静脉血栓形成率以及术后伤口皮缘坏死情况上相比差异无统计学意义（P>0.05）。结论 对于跟骨骨折手术治疗的患者局部联合静脉应用氨甲环酸可以减少围手术期失血、术后引流量以及降低术后伤口出现并发症的发生率且并不会增加发生血栓性疾病的风险。

Therapeutic effect of local combined intravenous application of tranexamic acid on calcaneal fractures

Objective To investigate the efficacy and safety of local combined intravenous application of Tranexamic acid (TXA) in the surgical treatment of calcaneal fractures.Methods Thirty-eight patients (all unilateral) with calcaneal fractures admitted to the Red Society Hospital of Xi''an Jiaotong University from December 2018 to November 2019 were randomly divided into two groups, including 20 in the observation group, 18 in the control group.Patients in the observation group : Intravenous drip of TXA (15ml / kg) after the start of the operation and local perfusion of TXA (15ml / kg) 5-10 minutes before the tourniquet is loosened; patients in the control group are intravenously dripped after the operation and 5-10 minutes before the tourniquet is loosened Application of local saline (15ml / kg). The intraoperative blood loss, postoperative blood loss, postoperative 48h drainage volume, preoperative and postoperative blood fibrinolytic level, hemoglobin index, perioperative venous thrombotic disease and postoperative wound complications were recorded and compared between the two groups of patients. Results 37 of the 38 patients healed in one stage. Intraoperative blood loss in the observation group was (79.5012.98) ml, and the control group was 93.7210.72 (ml). Postoperative blood loss in the observation group was (202.6536.75) ml, and in the control group (313.5054.59) ml. On the first day after operation, Hb (111.4510.52) g / L, control group (104.0511.07) g / L; observation group patients with drainage volume (189.9015.43) ml 48 hours after operation, and control group (252.2832.67) ml; In the observation group, 24hD dimer (4.251.85) mg / L, the control group (6.012.59) mg / L; in the observation group, 24hDDP (3.311.09) mg / L, and control group (4.651.87) mg / L; 72h postoperative FDP (3.111.03) mg / L in the observation group, and (4.221.71) mg / L in the control group; 1 case of postoperative wound swelling and exudation in the observation group and 6 cases in the control group. The observation group was better than the control group, and the differences were statistically significant (P <0.05). There was no significant difference in the rate of deep vein thrombosis of the lower extremities and necrosis of the wound skin after the two groups of patients (P> 0.05).Conclusion Local combined intravenous application of tranexamic acid for patients with calcaneal fracture surgery can reduce perioperative blood loss, postoperative drainage, and reduce the incidence of postoperative wound complications without increasing the risk of thrombotic disease.