氨甲环酸减少围手术期失血联合利伐沙班抗凝在股骨转子间骨折手术中的应用  

Efficacy of tranexamic acid on blood loss for the surgical treatment of intertrochanteric frac‑tures with rivaroxaban thromboprophylaxis

作　　者：陈硕[1] 陈昌礼[1] 银保 马宽[1] CHEN Shuo;CHEN Changli;YIN Bao;MA Kuan(Author Affiliation:Department of Orthopaedics,The Medical Center of Dujiangyan,Chengdu,Sichuan 611830,China)

机构地区：[1]都江堰市医疗中心骨科,四川成都611830

出　　处：《安徽医药》2021年第11期2298-2301,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的评估老年骨质疏松性股骨转子间骨折病人在采用利伐沙班预防血栓的同时,联用氨甲环酸(TXA)对于减少失血的安全性和有效性。方法纳入2017年12月至2018年12月都江堰市医疗中心老年股骨转子间骨折病人78例,所有病人均由同一治疗组医生采用股骨近端防旋髓内钉(PFNA)闭合复位内固定治疗,并接受利伐沙班的预防血栓治疗,其中41例围手术期联用TXA止血治疗(观察组),37例未使用TXA治疗(对照组)。比较两组术前血红蛋白、术中显性失血量、输血及并发症情况。结果观察组和对照组术前血红蛋白分别为(100.46±14.02)g/L及(99.30±12.48)g/L,差异无统计学意义(P>0.05)。观察组和对照组的术中显性失血量分别为(101.22±25.32)mL及(179.19±21.39)mL,差异有统计学意义(P<0.01)。观察组和对照组术后2 d复查血红蛋白指标分别为(73.62±14.67)g/L及(80.71±12.54)g/L,差异有统计学意义(P<0.05)。观察组和对照组分别有3例及10例病人输血,输血病例比例差异有统计学意义(P=0.031)。两组病人均无深静脉血栓事件发生。结论TXA用于PFNA的围手术期治疗,可减少围手术期失血,降低输血率,联合应用利伐沙班可有效预防下肢静脉血栓形成。Objective To assess the safty and efficacy of rivaroxaban thromboprophylaxis associated to tranexamic acid(TXA)in re‐ducing blood loss for the treatment of elderly patients with intertrochanteric fractures.Methods Seventy-eight elderly patients with in‐tertrochanteric fractures were treated with the proximal femoral nail anti-rotation(PFNA)in the Medical Center of Dujiangyan from Dec 2017 to Dec 2018.All patients received rivaroxaban thromboprophylaxis while forty-one patients received perioperative TXA(the exper‐imental group).Results The preoperative hemoglobin(Hb)level was(100.46±14.02)g/L and(99.30±12.48)g/L in TXA group and control group,respectively,there was no significant difference between the two groups.The postoperative bleeding was(101.22±25.32)mL and(179.19±21.39)mL in TXA group and control group,this difference was statistically significant(P<0.01).Postoperative D2 he‐moglobinemia were significantly lower in the TXA group(P<0.05).Three transfusions were required in the TXA group,versus ten in the control group,showed statistically significant difference in transfusion rates(P=0.031).No patient developed clinical evidence of ve‐nous thromboembolism.Conclusion Tranexamic acid was effective in reducing perioperative blood loss,transfusion rates,and associ‐ated to rivaroxaban was venous thromboembolism for the treatment of intertrochanteric fractures with PFNA.

关 键 词：髋骨折 氨甲环酸 利伐沙班 失血 手术 血栓形成倾向 静脉血栓栓塞症 

分 类 号：R687.3[医药卫生—骨科学]