氨甲环酸联合弹力绷带对跟骨骨折传统L型切口术后愈合和失血量的影响  

The effect of tranexamic acid combined with elastic bandage on the healing and blood loss after traditional L-shaped incision of calcaneal fractures

作　　者：杨佳瑞 王志猛 乔瑞 陈豪杰 张子龙 何晓[3] 熊晨 衡立松[2] 张堃[2] 樊伟[2] YANG Jiarui;WANG Zhimeng;QIAO Rui;CHEN Haojie;ZHANG Zilong;HE Xiao;XIONG Chen;HENG Lisong;ZHANG Kun;FAN Wei(Graduate School of Xi′an Medical University, Xi′an 710068, China;Department of Orthopaedics Trauma, Honghui Hospital Affiliated to Xi′an Jiaotong University, Xi′an 710054, China;Graduate School of Medicine, Yan′an University, Yan′an 716000, China)

机构地区：[1]西安医学院研究生处,710068 [2]西安交通大学附属红会医院创伤骨科,710054 [3]延安大学医学部研究生处,716000

出　　处：《国际骨科学杂志》2021年第3期183-188,共6页International Journal of Orthopaedics

基　　金：陕西省自然科学基金(2017ZDXM-SF-009)。

摘　　要：目的 探讨静脉应用氨甲环酸(TXA)联合弹力绷带在跟骨骨折患者围手术期应用的安全性、有效性及合理性。方法 选取2017年6月至2020年1月于西安交通大学附属红会医院行手术治疗的跟骨骨折患者154例,随机分为试验组(70例)和对照组(84例)。试验组于松止血带前5~10min静脉给予TXA 15mg/kg,术后使用弹力绷带由足底缠绕至膝上;对照组于松止血带前5~10min静脉给予等量生理盐水,术后不使用弹力绷带包扎。比较两组患者的失血量指标、失血相关实验室检查结果及并发症等情况。结果 两组患者的年龄、性别、体质指数、吸烟史、美国麻醉医师协会评级(ASA)、合并内科疾病、患肢侧别、术前血红蛋白(hb)、术前凝血指标、Sanders分型、术前下肢深静脉血栓(DVT)发生情况均无统计学差异(P>0.05)。术后第1天试验组hb为(118.21±11.96)g/L,对照组为(111.63±12.60)g/L。试验组术后48h引流量为(50.62±35.33)mL,对照组为(106.30±65.41)mL。试验组隐形失血量为(60.63±40.32)mL,对照组为(103.51±65.35)mL。试验组总失血量为(130.36±60.53)mL,对照组为(242.35±100.39)mL。试验组术后24hD-二聚体为(5.23±1.12)mg/L,对照组为(4.81±0.89)mg/L。术后疼痛视觉模拟评分(VAS)试验组为(4.01±1.12)分,对照组为(5.26±0.94)分。试验组住院时间为(6.81±1.35)d,对照组为(6.21±1.23)d。试验组切口干燥时间为(4.86±1.32)d,对照组为(6.91±1.52)d。以上数据两组比较差异均有统计学意义(P<0.05)。术后切口并发症:红肿渗出,试验组10例(14.28%),对照组23例(27.38%),两组间存在差异(P<0.05);皮下瘀斑血肿,试验组15例(21.42%),对照组31例(36.90%),两组间存在差异(P<0.05)。术后第1天、第3天及第4周,试验组DVT发生率与对照组比较差异均无统计学意义(P>0.05)。两组患者住院及术后复查随访期间均无有症状的肺栓塞发生。结论 使用TXA联合弹力绷带可有效降低跟骨骨折患者术后�Objective To explore the safety,efficacy and rationality of intravenous tranexamic acid(TXA)combined with elastic bandage in patients with calcaneal fractures during the perioperative period.Methods In this study,a prospective case-control study was performed to analyze the patients with calcaneal fractures undergoing surgery in Honghui Hospital Affiliated to Xi′an Jiaotong University from June 2017 to January 2020.A total of 154 patients were randomly divided into the experimental group(n=70)and control group(n=84).In the experimental group:15 mg/kg TXA was given intravenously 5 to 10 min before tourniquet was deflated,and elastic bandage was used to wrap from the sole of foot to above knee joint after operation.In the control group:the same amount of normal saline was given 5 to 10 min before tourniquet was deflated,and no elastic bandage was used after operation.The volume of blood loss,the results of laboratory tests related to blood loss and complications were compared between both groups.Results There was no significant difference in the age,sex,body mass index,smoking history,American Society of Anesthesiologists(ASA)scale,comorbidities,the side of injured foot,preoperative hemoglobin,preoperative coagulation index,Sanders′classification or preoperative deep venous thrombosis(DVT)of lower extremities between both groups(P>0.05).On the first day after operation,the level of hemoglobin in blood was(118.21±11.96)g/L in the experimental group and(111.63±12.60)g/L in the control group.Forty-eight hours after operation,the drainage volume was(50.62±35.33)mL in the experimental group and(106.30±65.41)mL in the control group.The amount of invisible blood loss was(60.63±40.32)mL in the experimental group and(103.51±65.35)mL in the control group.The total blood loss was(130.36±60.53)mL in the experimental group and(242.35±100.39)mL in the control group.Twenty-four hours after operation,the concentration of D-dimer in blood was(5.23±1.12)mg/L in the experimental group and(4.81±0.89)mg/L in the control g

关 键 词：氨甲环酸 弹力绷带 跟骨骨折 失血量 

分 类 号：R47[医药卫生—护理学]