不同剂量氨甲环酸治疗股骨头置换患者术中失血量和输血率的比较  

Comparison of blood loss and transfusion rates in patients treated with femoral head replacement at different doses of tranexamic acid

作　　者：戚颖 蔡明 刘肃[1] 马朋朋[1] 荣伟强 段娜娜 宗治国[1] 张鑫[1] 李伟[1] 张春玲[1] 张志伟 Qi Ying;Cai Ming;Liu Su;Ma Pengpeng;Rong Weiqiang;Duan Nana;Zong Zhiguo;Zhang Xin;Li Wei;Zhang Chunling;Zhang Zhiwei(First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000

出　　处：《中国医刊》2022年第9期977-981,共5页Chinese Journal of Medicine

基　　金：河北省医学科学研究重点课题(20150057);张家口市市级科技计划(2021061D)。

摘　　要：目的探讨静脉输注不同剂量氨甲环酸(tranexamic acid,TXA)对股骨头置换患者术中失血量和术后输血率的影响。方法选取2017年1月至2020年12月在河北北方学院附属第一医院因股骨颈骨折行股骨头置换术的老年患者90例,随机分为对照组、单剂量组、双剂量组,每组30例。对照组在切皮前15min及术后3h均静脉输注100ml生理盐水。单剂量组在切皮前15min将1g TXA加入100ml生理盐水后静脉输注,术后3h输注100ml生理盐水。双剂量组在切皮前15min及术后3h均将1g TXA加入100ml生理盐水后静脉输注。比较3组患者的术中失血量、术后输血率、术后24h及48h血红蛋白水平,并计算血红蛋白总损失量和红细胞总损失量。结果对照组术中失血量明显高于单剂量组及双剂量组,差异有显著性(P<0.05),而单剂量组与双剂量组术中失血量比较差异无显著性(P>0.05)。对照组的输血率明显高于单剂量组和双剂量组,且单剂量组明显高于双剂量组,差异均有显著性(P<0.05)。3组术前血红蛋白水平比较差异无显著性(P>0.05);术后24h及48h各组血红蛋白水平均明显低于术前,且对照组明显低于单剂量组和双剂量组,单剂量组明显低于双剂量组,差异均有显著性(P<0.05)。对照组血红蛋白总损失量和红细胞总损失量明显高于单剂量组和双剂量组,且单剂量组明显高于双剂量组,差异均有显著性(P<0.05)。结论TXA可以有效减少股骨头置换术中、术后出血量,降低输血率,且双剂量给药的效果优于单剂量给药。Objective To investigate the effect of intravenous infusion of tranexamic acid(TXA)on blood loss and postoperative transfusion rate of femoral head replacement.Method 90 elderly patients undergoing femoral head replacement due to femoral neck fracture were randomly divided into three groups:group A,group B and group C.Group A(control group)received intravenous infusion of 100ml normal saline(NS)15min before skin excision and 3h after surgery.In group B(single-dose group),1g TXA and 100ml NS were injected 15 min before skin resection,and 100ml NS were injected 3h after surgery.Group C(double-dose group)was infused with 1g TXA and 100 ml of NS for 15 minutes before excision and 3h after surgery.The intraoperative blood loss,postoperative transfusion rate,and hemoglobin levels at 24 and 48 hours postoperative were compared among the three groups and the total loss of haemoglobin and total erythrocyte loss were calculated.Result The total hemoglobin(Hb)loss of group A,B and C was(167.2±43.1)g,(121.6±35.7)g and(95.3±22.8)g respectively,group B and C compared with group A(P<0.05),group B compared with group C(P<0.05).The mean total erythrocyte loss of group A,B and C was 1491.4 ml,1090.1ml and 848.6ml,respectively.Compared with group A,group B and group C both were P<0.05.The blood transfusion rates of group A,B and C were 56.6%,33.3%and 10.0%,respectively.Compared with group A,the blood transfusion rates of group B and C both were P<0.05,and group B compared with group C were P<0.05.The average intraoperative blood loss of group A,B and C was 350ml,260ml and 250ml,respectively.Compared with group A,group B and group C both were P<0.05,and group B compared with group C was P>0.05.Hb levels at 24 hours after operation in group A,B and C were(87.6±10.5)g/L,(93.1±8.6)g/L and(97.2±7.4)g/L,respectively.Compared with group A,B and C were P<0.05,respectively.Hb levels at 48 hours after operation in group A,B and C were(80.1±10.2)g/L,(88.7±8.3)g/L and(92.9±6.6)g/L,respectively.Compared with group A,group B and group C

关 键 词：氨甲环酸 股骨颈骨折 股骨头置换 失血量 输血率 

分 类 号：R683.42[医药卫生—骨科学]