术前使用氨甲环酸减少老年股骨转子间骨折围手术期失血的临床研究  

作　　者：诸葛军 熊良平[2] 付小军[2] 

机构地区：[1]杭州市西溪医院,310023 [2]杭州市建德市第一人民医院,311600

出　　处：《浙江临床医学》2020年第6期867-868,876,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨在老年股骨转子间骨折股骨近端防旋髓内钉(PFNA)内固定术前使用氨甲环酸对隐性失血的影响。方法回顾性分析2015年7月至2018年7月期间本院收治的老年股骨转子间骨折病例资料,根据术前是否使用氨甲环酸分为两组:氨甲环酸组44例,对照组48例。收集术前、术后第1、3天患者血常规、术中失血量、术中输血量、术后引流量以及术后输血量。比较两组的各失血量、输血率、深静脉血栓(DVT)发生率等指标。结果氨甲环酸组总失血量平均(788.5±127.3)ml,隐性失血量平均(599.5±48.6)ml,输血率为13.6%,显著低于对照组[(1037.3±131.7)ml,(811.3±51.7)ml,37.5%],差异有统计学意义(P<0.05)。而两组之间的显性失血量比较差异无统计学意义(P>0.05)。氨甲环酸组3例小腿肌间DVT,对照组2例,差异无统计学意义(P>0.05)。结论术前应用氨甲环酸能有效降低老年股骨转子间骨折PFNA手术的总失血量、隐性失血量和输血率,无明显DVT形成风险。Objective To assess the effect of preoperative administration of tranexamic acid(TXA)on the blood loss in older intertrochanteric fracture patients treated with proximal femoral nail antirotation(PFNA).Methods The data of elderly patients with intertrochanteric fracture admitted to our hospital from July 2015 to July 2018 were analyzed retrospectively.According to whether tranexamic acid was used before operation,the patients were divided into two groups:tranexamic acid group(44 cases)and control group(48 cases).Blood routine(before and 1 and 3 days after operation),intraoperative blood loss,intraoperative blood transfusion,postoperative drainage and postoperative blood transfusion were collected.The blood loss,transfusion rate and incidence of deep venous thrombosis(DVT)were compared between the two groups.Results In TXA group,the total blood loss(788.5±127.3ml),the hidden blood loss(599.5±48.6ml)and the transfusion rate(13.6%)were significantly lower than those[(1037.3±131.7ml),(811.3±51.7),37.5%]in the control group.There was no significant difference between the 2 groups in visible blood loss.There were 3 cases of deep vein thrombosis between calf muscles in tranexamic acid group and 2 cases in control group(P>0.05).Conclusion Preoperative application of tranexamic acid can effectively reduce the total blood loss,occult blood loss and transfusion rate in elderly intertrochanteric fracture patients treated with PFNA.No significant risk of deep venous thrombosis is found.

关 键 词：氨甲环酸 髋骨折 失血 手术 

分 类 号：R68[医药卫生—骨科学]