不同时间点静脉滴注氨甲环酸对老年股骨转子间骨折行InterTan内固定术后失血量的影响及安全性评估  

Effect of intravenous infusion of tranexamic acid at different time points on postoperative blood loss after InterTan internal fixation in the elderly patients with intertrochanteric fractures and its safety evaluation

作　　者：刘程俊[1] 谢直跃[1] 段鑫[1] 杨立明[1] 顾祖超[1] LIU Chengjun;XIE Zhiyue;DUAN Xin;YANG Liming;GU Zuchao(Department of Orthopedics, Chengdu First People’s Hospital, Chengdu 610041, China)

机构地区：[1]成都市第一人民医院骨科

出　　处：《中国现代医生》2019年第23期74-78,共5页China Modern Doctor

摘　　要：目的探讨不同时间点静脉滴注氨甲环酸对老年股骨转子间骨折行InterTan内固定术后失血及术后深静脉血栓栓塞(DVT)的影响。方法选择105例老年股骨转子间骨折患者随机分为5组,每组21例,A组于手术结束前15 min给予1 g氨甲环酸静脉滴注;B 组于手术结束前15 min、术后7 h给予1 g氨甲环酸静脉滴注;C组于手术切皮前给予1 g氨甲环酸静脉滴注;D 组于手术切皮前给予1 g氨甲环酸,7 h后再给予1 g氨甲环酸静脉滴注;E组为对照组,不给予氨甲环酸。检测术后第1、3天血红蛋白、红细胞压积,术后第1天活化部分凝血酶时间等血液学指标,通过Gross方程计算围术期总失血量,比较5 组患者术中、术后失血量差异,以及患者输血率、血栓性并发症发生情况。结果 D 组围手术期总失血量,术后第1、3天血红蛋白及红细胞压积分别为(831.9±246.7)mL、(95.8±3.8)g/L、(86.6±6.7)g/L、(32.1±5.2)%、(29.3±4.1)%,均少于A组、B组、C组及E组(P<0.05)。E 组5项数值与其他各组比较有统计学意义(P<0.05)。A、B、C、D组患者的输血率(28.5%、19.0%、14.2%、9.5%)显著低于E组患者(42.8%),差异有统计学意义(P<0.05)。5组患者术后24 h凝血指标比较差异均无统计学意义(P>0.05)。5组患者术后均无腘静脉及其近端深静脉血栓及肺栓塞发生。结论手术切皮前给予1 g氨甲环酸,7 h后再给予1 g氨甲环酸静脉滴注在围手术期能够最大限度地减少术中及术后出血量。氨甲环酸在减少患者术后出血和输血率的同时,并不会增加DVT的发生。Objective To investigate the effects of intravenous infusion of tranexamic acid at different time points on postoperative blood loss and postoperative deep vein thromboembolism(DVT) after InterTan internal fixation in the elderly patients with intertrochanteric fractures. Methods 105 elderly patients with intertrochanteric fractures were randomly selected and divided into 5 groups, with 21 patients in each group. Group A was given intravenous infusion of 1 g of tranexamic acid 15 min before the end of surgery;group B was given intravenous infusion of 1 g of tranexamic acid 15 min before the end of surgery and 7 h after surgery;group C was given intravenous infusion of 1 g of tranexamic acid before surgical incision;group D was given intravenous infusion of 1 g of tranexamic acid before surgical incision, and was also given intravenous infusion of 1 g of tranexamic acid after 7 h;group E was the control group and no tranexamic acid was given. Hematological parameters such as hemoglobin and hematocrit on the 1st and 3rd day after surgery, and partial thrombin activation time on the first day after surgery were detected. The total perioperative blood loss was calculated by the Gross equation. The differences in intraoperative and postoperative blood loss as well as the transfusion rate and thrombotic complications were compared between the five groups. Results The total blood loss during perioperative period, and the hemoglobin and hematocrit 1 day and 3 days after surgery in group D were(831.9±246.7) mL,(95.8±3.8) g/L,(86.6±6.7) g/L,(32.1±5.2)%, and (29.3±4.1)%, which were all less than those in group A, group B, group C and group E(P<0.05). The five values in group E were statistically significant compared with the other groups(P<0.05). The transfusion rate (28.5%, 19.0%, 14.2%, 9.5%) of patients in group A, B, C, and D was significantly lower than that in group E(42.8%), and the differences were statistically significant(P<0.05). There were no statistically significant differences in coagulation indicators 2

关 键 词：氨甲环酸 股骨转子间骨折 失血 髋部联合加压交锁髓内钉 

分 类 号：R687.3[医药卫生—骨科学]