氨甲环酸全身与局部联合应用在股骨转子间骨折中的应用

目的:探讨氨甲环酸全身与局部联合应用在股骨转子间骨折中的应用。方法:自2017年1月至2019年10月收治100例股骨转子间骨折患者,按照随机数字表法分为观察组(48例)和对照组(52例)。所有患者接受相同的手术方式治疗,其中对照组术前20 min给予氨甲环酸治疗,将15 mg/kg稀释于250 ml氯化钠注射液,静脉滴注;观察组在对照组基础上于术中将氨甲环酸0.5 g溶于20 ml生理盐水注入股骨髓腔,进行局部治疗。比较两组失血量及手术时间、术后住院时间,分析两组手术前后血液指标红细胞压积、血红蛋白、D-二聚体及纤维蛋白原水平,并观察两组血栓类并发症发生情况。结果:观察组总失血量、显性失血量、隐性失血量及术后引流量均显著低于对照组(P0.05),术后住院时间显著短于对照组(P0.05)。两组术后血红蛋白及红细胞压积较术前均明显下降(P0.05),而观察组术后血红蛋白及红细胞压积显著高于对照组(P0.05)。观察组血栓性并发症发生率为10.42%,与对照组(11.54%)比较差异无统计学意义(P0.05)。结论:氨甲环酸全身与局部联合应用对降低股骨转子间骨折患者围手术期失血量、减少血细胞丢失具有重要临床意义,且安全性良好。

Application of tranexamic acid in the treatment of intertrochanteric fracture of femur

Objective: To investigate the application of tranexamic acid in the treatment of intertrochanteric fracture.Methods: From January 2017 to October 2019,100 patients with intertrochanteric fracture were randomly divided into observation group (48 cases) and control group(52 cases). All patients received the same surgical treatment. The control group was given tranexamic acid 20 minutes before operation,and 15 mg/kg diluted in 250 ml sodium chloride injection,intravenous drip;the observation group was given tranexamic acid 0.5 g dissolved in 20 ml normal saline injected into femoral bone marrow cavity for local treatment on the basis of the control group. The blood loss,operation time and postoperative hospital stay were compared between two groups. Hematocrit,hemoglobin,D-dimer and fibrinogen levels were analyzed before and after operation,and the incidence of thrombotic complications was observed.Results: The total blood loss,dominant blood loss,hidden blood loss and postoperative drainage volume of the observation group were significantly lower than those of the control group(P<0.05),and the postoperative hospital stay was significantly shorter than that of the control group(P<0.05). The postoperative hemoglobin and hematocrit of two groups were significantly lower than those before operation(P<0.05),while the postoperative hemoglobin and hematocrit of the observation group were significantly higher than those of the control group(P<0.05). The incidence of thrombotic complications in the observation group was 10.42%,which was not significantly different from that in the control group(11.54%)(P>0.05).Conclusion: Tranexamic acid combined with systemic and local application has important clinical significance in reducing perioperative blood loss and blood cell loss in patients with intertrochanteric fracture,and has good safety.