氨甲环酸治疗老年股骨转子间骨折髓内固定术后隐性失血的临床分析

Clinical research of tranexamic acid on the hidden blood Ioss after the treatment of intertrochanteric fractures with proximal femoral nail anti-rotation(PFNA)

目的研究应用氨甲环酸治疗转子间骨折髓内固定术后隐性失血的疗效。方法 56例老年股骨转子间骨折髓内固定患者随机分为2组。治疗组28例,术中扩髓前应用1 g氨甲环酸加入至250 mL生理盐水中静脉滴注;对照组28例,术中给予等量生理盐水静脉滴注。分别计算其总失血量、显性失血量及隐性失血量,对其结果进行对比。并术后10 d超声检查是否出现下肢静脉血栓。结果 2组患者总失血量比较差异有统计学意义(P<0.05)。隐性失血平均为(426.69±56.25)mL,明显低于对照组的(658.36±60.76)mL,组间比较差异有统计学意义(P<0.05)。而显性失血差异无统计学意义(P>0.05)。超声检查所有患者无下肢深静脉血栓形成。结论应用氨甲环酸治疗能有效减少转子间骨折髓内固定术后围术期失血量及隐性失血量,减少了输血患者人数及输血量。同时未增加血栓形成风险。

Objective To assess the impact of tranexamine acid on the hidden blood loss in intertrochanteric fractures treated with proximal femoral nail anti-rotation （PFNA）. Methods 56 cases patients with intertrochanteric fractured treated with PFNA were randomly divided into two groups. Group A included 28 cases with tranexanfic acid. And the patients in this group were given 1 g tranexamieacid with 250 mL normal saline when the surgery started. The controls included 28 cases without tranexamic acid, in which the patients were just given 250 mL normal saline. The total red bloodcell loss, visible red blood cell loss and hidden red blood cell loss of the two groups were measured and the comparative analysis was conducted. Results The results of the hidden red blood loss in treatment group and control group were （426.69±56.25）mL and （658.36±60.76）mL, the hidden blood cell losses in group A were both significantly less than those in group B（P〈0. 05）. The visible blood loss was unchanged at the same time. Conclusion Ranexamic acid can reduce both the visible and hidden red blood loss after the treatment ofintertrochanteric fractures with PFNA.