序贯应用氨甲环酸对老年股骨颈骨折全髋关节置换术失血的疗效分析  

Effects of tranexamic acid sequential application of femoral neck fracture in the elderly patients on perioperative blood loss after total hip arthroplasty

作　　者：付廷 舒科杰 尹良军[2] FU Ting;SHU Kejie;YIN Liangjun(Department of Orthopedics,People′s Hospital of Fuyang,Fuyang,Anhui 236000,China;Department of Orthopedics,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]安徽省阜阳市人民医院骨科,安徽阜阳236000 [2]重庆医科大学附属第二医院骨科,重庆400010

出　　处：《检验医学与临床》2019年第20期2982-2984,2988,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨多途径、序贯应用氨甲环酸对老年股骨颈骨折行全髋关节置换术失血的临床疗效。方法选取2015年6月至2016年6月行单侧生物型人工全髋关节置换术的41例老年患者作为研究对象,分为两组:A组23例,男9例,女14例,于术前15min静脉滴注1g氨甲环酸,关闭切口后通过引流管注射0.3g氨甲环酸,术后夹闭引流管6h,术后3h静脉滴注1g氨甲环酸;B组18例,男8例,女10例,于术前15min、术后3h静脉滴注生理盐水,引流管内注射等量生理盐水并夹闭引流管6h。记录两组患者术中出血量、术后引流量,根据身高、体质量和术前、术后3d红细胞比容计算患者隐性失血量及失血总量,观察患者有无相关并发症及输血情况。结果A组和B组患者术中出血量、术后引流量、隐性失血量及总失血量比较,差异均有统计学意义(P<0.05);A组和B组患者术后切口感染、肺栓塞/深静脉血栓、认知功能障碍等并发症比较,差异均无统计学意义(P>0.05);A组和B组患者输血率比较,差异有统计学意义(P<0.05)。结论多途径、序贯应用氨甲环酸能有效减少老年股骨颈骨折全髋关节置换术失血量,降低术后输血率,并且不增加术后并发症风险。Objective To explore clinical effect of multi-channel and sequential application of tranexamic acid on blood loss of the elderly patients with femoral neck fracture in total hip arthroplasty(THA).Methods A total of 41 the elderly patients who received unilateral bioartificial THA from June 2015 to June 2016 were scheduled and divided into two groups:23 cases in group A,9 males and 14 females.Group A received intravenous dripping with 1 g tranexamic acid at preoperative 15 min and postoperative 3 h,through drainage tube injection with 0.3 g tranexamic acid after wound closure and the drainage tube was clamped at postoperative 6 h.While there were 18 cases in group B,including 8 males and 10 females.Tranexamic acid was replaced by equivalent normal saline under the same operation.Intraoperative blood loss and postoperative drainage were recorded.Total blood loss and hidden blood loss were calculated by the body weight,height and the hematocrit of preoperative and postoperative 3 days.Related complications and blood transfusion were observed.Results The differences were statistically significant in patients between group A and B with intraoperative blood loss,postoperative drainage,hidden blood loss and total blood loss(P<0.05).There were no significant differences in patients of group A and B with postoperative wound infection,pulmonary embolism/deep vein thrombosis,cognitive dysfunction(P>0.05).The difference was statistically significant in blood transfusion rate between group A and B(P<0.05).Conclusion Multi-channel and sequential application of tranexamic acid could effectively decrease total blood loss and the ratio of postoperative blood transfusions without increasing risk for postoperative complications during the THA in the elderly patients.

关 键 词：全髋关节置换术 氨甲环酸 失血 序贯应用 

分 类 号：R683.42[医药卫生—骨科学]