静脉注射不同剂量氨甲环酸对老年股骨转子间骨折行股骨近端防旋髓内钉固定术后炎症反应及纤溶活性的初步观察  

Preliminary observation on the inflammatory response and fibrinolytic activity of intravenous injection of different doses of Tranexamic Acid after proximal femoral nail antirotation fixation in elderly patients with intertrochanteric fractures

作　　者：张育斌[1] 陈淑燕 ZHANG Yubin;CHEN Shuyan(Department of Orthopedic,People's Hospital of Puning City,Guangdong Province,Puning515300,China)

机构地区：[1]广东省普宁市人民医院骨科,广东普宁515300

出　　处：《中国当代医药》2023年第18期62-66,共5页China Modern Medicine

基　　金：广东省揭阳市科技计划项目(190823112354131)。

摘　　要：目的探讨静脉注射不同剂量氨甲环酸(TXA)对老年股骨转子间骨折行股骨近端防旋髓内钉(PFNA)固定术后炎症反应及纤溶活性。方法选取2019年7月至2021年1月广东省普宁市人民医院收治的120例实施PFNA术的老年股骨转子间骨折患者作为研究对象,采用随机数字表法将患者分为A组(40例)、B组(40例)、C组(40例)。A组采用术前30 min静滴10 mg/kg TXA;B组采用术前30 min静滴15 mg/kg TXA;C组采用术前30 min静滴相等剂量的生理盐水。比较三组患者的失血量、血红蛋白、纤维蛋白酶降解产物(FDP)、D-二聚体(D-D)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平、深静脉栓塞发生率和输血率。结果三组患者的总失血量、术中失血量和隐性失血量比较,差异有统计学意义(P<0.05);三组患者术后第1、4天的血红蛋白、FDP和D-D水平比较,差异有统计学意义(P<0.05);三组患者术后第1、4天的CRP和IL-6水平比较,差异有统计学意义(P<0.05);三组患者术后第1、7天的深静脉血栓发生率比较,差异无统计学意义(P>0.05);三组患者的输血率比较,差异有统计学意义(P<0.05)。结论术前静脉注射TXA可以减少老年性股骨转子间骨折行PFNA术围手术期出血量及隐性失血量,应用15 mg/kg剂量TXA的患者效果更为明显,其抗纤溶性及抗炎效果随剂量增加而增强,而剂量的增加不会增加术后双下肢发生静脉血栓的风险。Objective To explore the intravenous injection of different doses of Tranexamic Acid(TXA)on the inflammatory response and fibrinolytic activity after proximal femoral nail antirotation(PFNA)fixation in elderly patients with intertrochanteric fractures.Methods A total of 120 elderly patients with intertrochanteric fractures of the femur who underwent PFNA surgery were admitted to the People's Hospital of Puning City,Guangdong Province from July 2019 to January 2021 were selected as the study subjects,the patients were randomly divided into group A(40 cases),group B(40 cases),and group C(40 cases)according to a random number table method.Group A received intravenous infusion of 10 mg/kg TXA 30 minutes before surgery,group B received intravenous infusion of 15 mg/kg TXA 30 minutes before surgery,group C was given an equal dose of physiological saline intravenously 30 minutes before surgery.The blood loss,hemoglobin,fibrinolytic degradation products(FDP),D-dimer(D-D),C-reactive protein(CRP),interleukin-6(IL-6)levels,incidence of deep vein thrombosis,and transfusion rates were compared among three groups of patients.Results The total blood loss,intraoperative blood loss,and occult blood loss of the three groups of patients were compared,the differences were statistically significant(P<0.05).The levels of hemoglobin,FDP and D-D were compared among the three groups of patients on the 1st and 4th day after surgery,the differences were statistically significant(P<0.05).The levels of CRP and IL-6 were compared among the three groups of patients on the 1st and 4th day after surgery,the differences were statistically significant(P<0.05).The incidence of deep vein thrombosis on the 1st and 7th day after surgery were compared among the three groups,the differences were not statistically significant(P>0.05).The blood transfusion rate of the three groups of patients was compared,the difference was statistically significant(P<0.05).Conclusion Preoperative intravenous injection of TXA can reduce perioperative blood loss and recess

关 键 词：老年患者 股骨转子间骨折 氨甲环酸 炎症反应 纤溶活性 

分 类 号：R68[医药卫生—骨科学]