氨甲环酸降低股骨粗隆间骨折PFNA术后失血量的临床研究

Efficacy and Safety of Systemic Administration of Tranexamic Acid for Blood Salvage in Patients Undergoing PFNA Operation for Intertrochanteric Fracture

目的股骨粗隆间骨折患者股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)围术期较大的失血量是其术后高病死率的原因之一,本研究的目的是评价氨甲环酸降低PFNA术中、术后失血量的有效性与安全性。方法回顾性分析2013年1月至2014年12月在我科行PFNA手术的股骨粗隆间骨折患者,根据是否在术前30min内使用氨甲环酸分为TA组和对照组。TA组共56例,男20例,女32例,平均年龄(71.35±5.40)岁;对照组共52例,男20例,女32例,平均年龄(71.69±5.51)岁。记录两组患者人口学资料与术后血红蛋白水平,统计深静脉血栓(deepvenousthrombosis,DVT)发生率。结果TA组总失血量为(541.05±162.18)mL,对照组为(803.10±264.86)mL。两组相比差异具有统计学意义(P=0.000)。TA组平均输血率为12.5%(7/56),对照组30.7%(16/52)。两组相比差异具有统计学意义(P=0.020)。两组DVT发生率相比差异无统计学意义。结论氨甲环酸静脉滴注可明显降低PFNA术后失血量及输血需求,而且不增加术后DVT发生风险。

Objective To evaluate the efficiency and safety of systemic application of tranexamic acid（TA）for blood salvage during operation of proximal femoral nail anti-rotation（PFNA）for patients sustained inter-trochancteric fracture.Methods We retrospectively enrolled 108 patients operated from Janury 2013 to December 2014 and divided them in to two groups which were then named TA group（56 patients）and control group（52 patients）according to whether TA was administrated or not.We then compared change in hemoglobin,transfusion rates,hemoglobin at 4-5 days after operation and complications between the two groups.Results The total blood loss was less for patients in the TA group than for the control group（541.05±162.18）mL versus（803.10±264.86）mL,respectively.The blood transfusion rate was also less for patients in the TA group than for the control group：12.5%（7/56）versus 30.7%（16/52）,respectively.The rate of deep venous thromembolism of two groups had no significant difference.Conclusion Systemic tranexamic acid administration can efficiently reduce blood loss after PFNA without obvious adverse outcomes.