氨甲环酸序贯使用在老年股骨颈骨折半髋置换围手术期应用的安全性和有效性  

The safety and efficacy of sequential use of tranexamic acid in perioperative period of half hip replacement for femoral neck fracture in the elderly

作　　者：王美福[1] 周德春[1] 王亚全[1] 王浩洋[2] 周宗科[2] WANG Meifu;ZHOU Dechun;WANG Yaquan;WANG Haoyang;ZHOU Zongke(Department of Orthopedics,Meishan Traditional Chinese Medicine Hospital,Meishan,Sichuan 620010,P.R.China;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]眉山市中医医院骨外科,四川眉山620010 [2]四川大学华西医院骨科,成都610041

出　　处：《华西医学》2020年第1期41-45,共5页West China Medical Journal

基　　金：四川省科学技术厅重点研发项目(2018SZ0051)

摘　　要：目的探讨氨甲环酸序贯使用在老年股骨颈骨折半髋置换围手术期应用的安全性和有效性。方法回顾性纳入2016年1月-2018年10月于眉山市中医医院因股骨颈骨折行半髋置换的患者。根据围手术期氨甲环酸使用情况,将患者分为不用药组、手术当天用药组、序贯用药组。记录并统计不同氨甲环酸使用方法的3组患者围手术期血液丢失、输血情况及深静脉血栓形成发生率。结果共纳入患者113例,最终入组99例,其中不用药组31例,手术当天用药组36例,序贯用药组32例。3组患者在年龄、性别、体质量指数、入院时血红蛋白水平(hemoglobin,Hb)、入院时红细胞比容、血容量、输血率等方面比较,差异均无统计学意义(P>0.05);在总失血量(F=43.613,P<0.001)、术前失血量(F=4.746,P=0.011)、术前Hb(F=6.220,P=0.003)、最大Hb变化(F=18.913,P<0.001)、术后住院日(F=43.511,P<0.001)方面比较,差异均有统计学意义,且均未发现腘静脉(包含)及其近端的知名静脉血栓形成。除不用药组与手术当天用药组在术前失血量、术前Hb,手术当天用药组与序贯用药组在术后住院日方面比较,差异无统计学意义外(P>0.05),其余指标在3组间两两比较,差异均有统计学意义(P<0.05)。结论股骨颈骨折伤后早期使用氨甲环酸并序贯使用至手术当日可以减少围手术期的血液丢失,包括伤后等待手术期间的隐性失血和围手术期总的血液丢失,有利于患者术后恢复,且不增加围手术期下肢静脉血栓形成的发生风险。Objective To investigate the safety and efficacy of sequential use of tranexamic acid(TXA)in the perioperative period of half hip replacement for femoral neck fracture in the elderly.Methods Patients who underwent hemiarthroplasty due to femoral neck fracture in Meishan Traditional Chinese Medicine Hospital from January 2016 to October 2018 were retrospectively included.According to the use of TXA during the perioperative period,the patients were divided into group A(no use of TXA),group B(TXA use on the day of surgery),and group C(sequential therapy).The perioperative blood loss,blood transfusion rate and incidence of deep vein thrombosis(DVT)in the 3 groups were recorded and counted.Results A total of 113 patients were included,and 99 patients were finally included(31 in group A,36 in group B,and 32 in group C).There were no statistically significant difference in age,sex,body mass index,hemoglobin(Hb)at admission,hematocrit at admission,blood volume,or blood transfusion among the three groups.The differences in total blood loss(F=43.613,P<0.001),preoperative blood loss(F=4.746,P=0.011),preoperative Hb(F=6.220,P=0.003),maximum Hb change(F=18.913,P<0.001),and postoperative length of hospital stay(F=43.511,P<0.001)among the three groups were statistically significant.There was no DVT of the lower extremities or pulmonary embolism found in the three groups.The differences in preoperative blood loss and preoperative Hb were not statistically significant between group A and group B.The difference in postoperative length of hospital stay was not statistically significant between group B and group C.The differences in other indexes between all the pairs of the three groups were statistically significant(P<0.05).Conclusion Using TXA early after femoral neck fracture and sequentially to the day of surgery can reduce perioperative blood loss,including hidden blood loss before surgery and blood loss during and after the operation,which is beneficial to patients’postoperative recovery without increasing the risk of DVT.

关 键 词：股骨颈骨折 氨甲环酸 半髋置换 

分 类 号：R687.3[医药卫生—骨科学]