氨甲环酸减少老年髋部骨折患者围术期失血量的临床研究  

Clinical research on tranexamic acid in reducing perioperative blood loss in geriatric patients with hip fracture

作　　者：秦伟铖 方跃[1] 邹昌[1] 林弋翔 Qin Weicheng;Fang Yue;Zou Chang;Lin Yixiang(Department of Orthopedics,Sichuan University West China Hospital,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华老年医学杂志》2022年第7期785-788,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨静脉滴注氨甲环酸(TXA)对老年髋部骨折患者围术期失血量的影响。方法回顾性研究,选取2020年6月至2021年6月因髋部骨折在四川大学华西医院创伤骨科接受治疗的95例患者的临床资料,其中54例65~100岁老年患者入选。患者均进行闭合防旋股骨近端髓内钉复位手术,依据围术期是否使用TXA及使用方法不同分为3组,围术期予以静脉滴注生理盐水的患者18例为对照组;术前30 min内予以静脉滴注TXA 25 mg/kg的18例患者为单次用药组;术前30 min内予以静脉滴注TXA 25 mg/kg,术后3 h、6 h各追加15 mg/kg TXA的患者18例为重复用药组。比较3组患者总失血量、术后深静脉血栓发生率。结果对照组、单次用药组、重复用药组患者性别、年龄、术前血小板、术前活化部分凝血酶时间、术前凝血酶原时间比较,差异无统计学意义(均P>0.05)。对照组、单次用药组、重复用药组患者围术期估计失血量分别为620(330,1080)ml、380(270,490)ml、520(190,750)ml,3组比较差异有统计学意义(H=8.666,P<0.05)。其中单次用药组的总失血量低于对照组,差异均具有统计学意义(P<0.05)。重复用药组的总失血量较对照组较少,失血量超过单次用药组,但差异无统计学意义(P>0.05)。3组患者术后第1、7 d行彩色超声检查,均无下肢深静脉血栓和肺栓塞。结论术前30 min静脉滴注TXA能有效降低围术期总失血量,且不增加深静脉血栓形成风险。相对于术前单次静脉滴注TXA,重复使用TXA应慎重考虑。Objective To investigate the efficacy of intravenous infusion of tranexamic acid(TXA)on perioperative blood loss in geriatric patients with hip fracture.Methods In this retrospective study,54 out of 95 patients with hip fracture aged from 65 years to 100 years,treated at the Department of Trauma and Osteology,West China Hospital of Sichuan University from June 2020 to June 2021 were finally enrolled.Their clinical data were collected.All patients underwent closed reduction PFNA surgery.They were divided into three groups:(1)Control group(n=18):intravenous infusion of normal saline at 30 min before surgery;(2)Single dose group(n=18):TXA(25 mg/kg)was intravenously injected at 30min before surgery;(3)multiple dose group(n=18):25 mg/kg of TXA was intravenously injected at 30 min before surgery and 15 mg/kg injected again at 3 h and 6 h after surgery.Total blood loss and the incidence of postoperative deep venous thrombosis among 3 group patients were compared.Results There were no statistically significant differences in gender,age,preoperative platelets,preoperative activated partial thrombin time and preoperative prothrombin time among control group,single dose group and multiple dose group(all P>0.05).Perioperative blood loss was estimated to be 620(330,1080)ml,380(270,490)ml and 520(190,750)ml in the control group,single dose group and multiple dose group,respectively,with statistical significance(H=8.666,P<0.05).Total blood loss in single dose group was less than in both control(P<0.05,with statistical significance)and in multiple groups(P>0.05,without statistical significance),and total blood loss in multiple dose group was lower than in control(P>0.05,without statistical significance),and higher than in single dose group(P>0.05,without statistical significance).Color ultrasonography was performed on the 1st and 7th day after surgery in 3 groups,and no deep venous thrombosis or pulmonary embolism was found in all groups.Conclusions Intravenous infusion of TXA at half an hour before surgery can effectively reduc

关 键 词：氨甲环酸 髋骨折 股骨骨折 失血 手术 

分 类 号：R687.3[医药卫生—骨科学]