氨甲环酸减少股骨粗隆间骨折PFNA内固定手术隐性失血的随机对照试验

Tranexamic acid reducing hidden blood loss in treatment of fermoral intertrochanteric fractures with internal fixation of PFNA: a randomized controlled trial

目的探讨手术开始前静脉输注氨甲环酸能否减少股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定手术患者的隐性失血量。方法纳入自2016-12—2017-07行PFNA内固定治疗的77例股骨粗隆间骨折,随机分为2组,氨甲环酸组(37例)于麻醉后手术开始前静脉输注氨甲环酸1 g(200 ml),生理盐水组(40例)静脉输注200 ml生理盐水。比较2组手术时间、术中出血量、术后第2天引流量、术后输血率、术后早期并发症发生率,术后第1天及第3天Hb、Hct,术后第3天总失血量、显性失血量、隐性失血量。结果与生理盐水组比较,氨甲环酸组术后第3天总失血量及隐性失血量更少,术后输血率更低,差异有统计学意义(P <0.05);而2组手术时间、术中出血量、术后第2天引流量、术后Hb、术后Hct、术后第3天显性失血量、早期并发症发生率比较差异无统计学意义(P>0.05)。结论麻醉后手术开始前静脉输注1 g氨甲环酸可以有效减少股骨粗隆间骨折PFNA内固定手术患者的隐性失血量,降低术后患者输血率,进而减少贫血导致的严重并发症,同时不增加血栓的发生率。

Objective To investigate whether the preoperative intravenous injection of tranexamic acid could reduce hidden blood loss in patients undergoing internal fixation with proximal femoral nail antirotation (PFNA) for femoral intertrochanteric fracture.Methods Seventy-seven cases of femoral intertrochanteric fracture were included undergoing PFNA fixation from December 2016 to July 2017,and were randomly divided into two groups,the tranexamic acid group (37 cases) received intravenous infusion of 1 g (200 ml) of tranexamic acid preoperative after anesthesia while the saline group (40 cases) received intravenous infusion of 200 ml saline.The operation time,intraoperative blood loss,drainage volume on the second day after operation,postoperative blood transfusion rate,early postoperative complication rate,Hb and Hct on the first day and the third day after operation,total blood loss,visible blood loss,and hidden blood loss on the third day after operation were compared between the two groups.Results Compared with the normal saline group,the total blood loss and hidden blood loss were less and the postoperative blood transfusion rate was lower in the tranexamic acid group,and the difference was statistically significant (P <0.05).However,there was no statistically significant difference in operation time,intraoperative blood loss,postoperative drainage volume on the second day after operation,postoperative Hb and Hct,and postoperative visible blood loss on the third day after operation,early complications between the two groups (P >0.05).Conclusion After anesthesia,preoperative intravenous injection of 1 g of tamaric acid can effectively reduce the hidden blood loss of patients with PFNA internal fixation for femoral intertrochanteric fracture,reduce the postoperative blood transfusion rate,and thereby reduce the serious complications caused by anemia,without increasing the incidence of thrombosis.