围手术期多次静脉应用氨甲环酸减少股骨转子间骨折术后隐形失血的临床研究  

The clinical study on intravenous tranexamic acid for reducing perioperative blood loss in elderly patients undergoing femoral intertrochanteric fracture fixation

作　　者：王雨辰[1] 俞伟忠[1] 刘延辉[1] 吴国明 徐鹏[1] 鄂远 WANG Yuchen;YU Weizhong;LIU Yanhui;WU Guoming;XU Peng;E Yuan(Department of Orthopaedic Surgery, The Wujin Affiliated Hospital of Nanjing University of Traditional Chinese Hospital,Changzhou,Jiangsu 213161,China)

机构地区：[1]南京中医药大学武进附属医院,江苏常州213161

出　　处：《重庆医学》2019年第A01期57-59,共3页Chongqing medicine

基　　金：常州市武进区科技项目(WS201711)。

摘　　要：目的评价围手术期多次静脉使用氨甲环酸(TXA)减少股骨转子间骨折术后隐性失血量的有效性和安全性。方法回顾性分析2013年6月1日至2016年6月1日该院骨伤科收治的接受手术治疗的90例老年转子间骨折患者的临床资料,根据是否围手术期使用TXA及应用次数分为单次应用组、多次应用组和对照组,每组30例。单次应用组术前15min静脉滴注TXA1g,多次应用组术前15min,术后3、6h各静脉滴注TXA1g,对照组围手术期不应用TXA。检测3组患者术前、术后第3天血红蛋白和血细胞比容,术后7d进行下肢彩色多普勒超声检查。结果单次应用组患者隐性失血量[(431.60±210.79)mL]明显少于对照组[(744.83±276.84)mL],多次应用组患者隐性失血量[(311.87±111.02)mL]明显少于单次应用组,差异均有统计学意义(P<0.05)。3组患者均无肺栓塞及下肢深静脉血栓形成。结论应用TXA可减少股骨转子间骨折术后隐形失血,多次重复应用TXA可进一步减少围手术期隐性失血,2种应用方式均未增加发生血栓的风险。Objective To Evaluate the efficacy and safety of intravenous tranexamicacid for reducing perioperative hiddern blood loss in femoral intertrochanteric fracture fixation. Methods Review 90 patients with intertrochanteric fracture underwent internal fixation between June 2013 and June 2016. As to how TXA was administrated,the patients were randomly divided into three groups with 30 patients each.The mono-injection group with TXA at 1 g intravenously before the operation,the multiple-injection group with TXA at a dose of 1g before operation and twice at 3-hour intervals postoperatively,control group without TXA given.The hemoglobin(Hb),hematocrit(Hct),were tested preoperatively and at 3 day postoperatively.All patients received color Doppler examination of both lower extremities at 7 d after operation. Results The hidden blood loss in the mono-injection group was(431.60±210.79)mL,which was significantly lower than that in the control group(744.83±276.84)mL( P <0.05).The hidden blood loss in the multiple-injection group(311.87±111.02)mL significantly less than that in mono-injection group.Pulmonary embolism and deep vein thrombosis were not observed in any group. Conclusion Intravenous TXA is effective in reducing hidden perioperative blood loss in femoral intertrochanteric fracture surgery,Additionally,multiple doses of intravenous TXA get better result than the single dose of intravenous TXA without increasing the risk of thrombosis.

关 键 词：氨甲环酸 股骨转子间骨折 隐性失血量 

分 类 号：R683.420.5[医药卫生—骨科学]