氨甲环酸降低老年转子间骨折围术期失血的临床研究  

Clinical study of tranexamic acid to reduce perioperative blood loss in elderly people with intertrochanteric fracture

作　　者：周述清 杨博文 叶健 张孝华 税巍 倪卫东[2] ZHOU Shuqing;YANG Bowen;YE Jian;ZHANG Xiaohua;SHUI Wei;NI Weidong(Department of Orthopedics,Jiangjin District Central Hospital,Chongqing 402260,China;Department of Orthopedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆市江津区中心医院骨二科,402260 [2]重庆医科大学附属第一医院骨科,400016

出　　处：《重庆医学》2022年第6期1003-1007,共5页Chongqing medicine

基　　金：重庆市江津区科技局攻关项目(Y2017214)。

摘　　要：目的探讨静脉、局部、静脉联合局部应用氨甲环酸减少股骨转子间骨折股骨近端防旋髓内钉(PFNA)内固定术围术期失血的疗效。方法选取2017年10月至2019年9月重庆市江津区中心医院行PFNA手术治疗的144例股骨转子间骨折(ITF)患者为研究对象,其中男51例,女93例,年龄65~100岁。根据氨甲环酸的使用方式分为静脉组、局部组和联合组。记录手术时间、术中失血量、输血量、术后血红蛋白、手术切口愈合、胃肠道反应、血栓相关并发症等。结果静脉组、联合组显性失血量低于局部组,联合组隐性失血及总失血量低于静脉组和局部组,输血率及输血量联合组更低,差异有统计学意义(P<0.05)。静脉组术后当天胃肠道反应发生率高于其他两组,差异有统计学意义(P<0.05)。结论老年ITF患者PFNA内固定围术期静脉联合局部应用氨甲环酸更利于减少失血。Objective To investigate the efficacy of intravenous,topical,and combined intravenous topical application of tranexamic acid to reduce blood loss during the perioperative period of proximal femoral nail antirotation(PFNA)internal fixation for intertrochanteric femoral fractures.Methods A total of 144 patients with intertrochanteric femur fracture(ITF)treated by PFNA surgery at Jiangjin District Central Hospital in Chongqing from October 2017 to September 2019 were selected for the study,including 51 males and 93 females,aged 65 to 100 years.They were divided into the intravenous group,local group and combined group according to the use of tranexamic acid.The duration of surgery,intraoperative blood loss,blood transfusion,postoperative haemoglobin,surgical incision healing,gastrointestinal reactions and thrombosis-related complications were recorded.Results The amount of overt blood loss in the intravenous and combined groups was lower than that in the local group,while the amount of occult blood loss and total blood loss in the combined group was lower than that in the intravenous and local groups,and the rate of postoperative transfusion and the amount of transfusion in the combined group were lower.The incidence of gastrointestinal reactions on the day after surgery was higher in the intravenous group than in the other two groups,with a statistically significant difference(P<0.05).Conclusion Intravenous combined with topical tranexamic acid during the perioperative period of PFNA internal fixation in elderly patients with ITF is more beneficial in reducing blood loss.

关 键 词：转子间骨折 股骨近端防旋髓内钉 老年人 隐性失血 氨甲环酸 快速康复 

分 类 号：R683.42[医药卫生—骨科学]