乳酸亚铁治疗股骨粗隆间骨折隐性失血的疗效分析

目的探讨股骨粗隆间骨折术后隐性失血的原因及乳酸亚铁治疗隐性失血对术后功能的影响。方法将182例股骨粗隆间骨折患者随机分组。试验组口服乳酸亚铁8周,对照组未进行干预。均采用手术治疗,在入院当天,术后前3 d,出院时及手术后第1、3、6个月检测血红蛋白和血清铁蛋白,并用股四头肌功能恢复及下床时间评价患者功能情况。结果 182例患者有2例失访,试验组89例、对照组91例进入最终研究分析。手术前试验组和对照组血红蛋白分别为(121.3±6.7)g/L和(120.5±7.0)g/L,差异无统计学意义(P=0.472);手术前试验组和对照组血清铁蛋白分别为(13.2±0.5)μg/L和(12.9±0.7)μg/L,差异无统计学意义(P=0.472)。手术3 d后两组的血红蛋白和血清铁蛋白较术前明显下降,但两组之间的差异无统计学意义(P>0.05)。术后第1、3、6个月试验组血红蛋白增加量均明显高于对照组(P<0.05);术后第1、3、6个月试验组FIM评分增加值均明显高于对照组,差异有统计学意义(P<0.05)。本研究中Evans各型之间术后3 d内血红蛋白下降量之间的差异无统计学意义。结论股骨粗隆间骨折不同Evans类型间术后隐性失血量无明显差异。口服乳酸亚铁能有效防治隐性失血,加快患者术后功能恢复。

Objective To investigate the reasons of hidden hemorrhage after the operation of intertrochanteric fractures,and how ferrous lactate treatment effects postoperative functions. Methods A stochastic grouping method was introduced for 182 cases of intertrochanteric fractures patients dated between April 2008 and April 2013. Test group was treated by oral administration of ferrous lactate for eight weeks, and Control group was not intervened. All patients took surgical treatment. Detection of hemoglobin and serum ferritin was conducted on the day of admission, the third day prior and after the surgery, the day discharged from hospital, and also the 1 st, 3 rd and 6 th month after the surgical;besides, quadriceps functional recovery and ambulation hour were recorded for the patients＇functional evaluation. Results 182 cases of patients with two cases were lost, the test group 89 cases, 91 cases of the control group entered the final analysis. Before surgical, the hemoglobin of Test group and Control group were （121.3±6.7） g/L and （120.5±7.0） g/L respectively, with a difference not statistically significant（P=0.472）. Three days after the surgical, hemoglobin and serum ferritin of both groups had an obvious decrease compared to figures of preoperative, but still with a difference of no statistical significance （P〉0.05）.The 1st, 3rd and 6th month after the surgical, the increase amount of hemoglobin in Test group was significantly higher than that in Control group （P〈0.05）. Similarly, The added value of grading for the FIM of Test group was also higher than that of Control group, with a difference of statistical significance （P〈0.05）. In this research, the difference of hemoglobin decrease amount between Evans types detected 3 days after surgical is of no statistical significance. Conclusion Evans intertrochanteric fractures of different types of hidden hemorrhage among patients showed no significant difference. Oral ferrous lactate can effectively prevent hidden blood loss, accelerated postoperative functional recovery.