加味桃红四物汤对老年股骨转子间骨折股骨近端防旋髓内钉内固定术围手术期隐性失血的影响

Influence of Jiawei Taohong Siwu Tang( 加味桃红四物汤) on perioperative hidden blood loss in aged patients who received proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures

目的:探讨围手术期应用加味桃红四物汤对老年股骨转子间骨折股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术围手术期隐性失血的影响及其安全性。方法:将78例老年股骨转子间骨折患者随机分为加味桃红四物汤组(38例)和常规治疗组(40例)。所有患者均由同一组医生完成PFNA内固定手术,术后12 h开始皮下注射低分子量肝素注射液,每天1次,连用7 d。加味桃红四物汤组自入院2 h后即口服加味桃红四物汤,直至术后第7天,手术日停服1次。常规治疗组除不口服加味桃红四物汤外,其余治疗均与加味桃红四物汤组相同。测定2组患者的失血量,术后7 d时通过超声检查观察下肢静脉血栓形成情况。结果:加味桃红四物汤组的失血总量和术后隐性失血量均低于常规治疗组[(1 240.0±297.0)mL,(1 475.0±300.0)mL,t=-124.637,P=0.000;(797.0±290.0)mL,(988.0±288.0)mL,t=-80.898,P=0.000];2组患者显性失血量和术前隐性失血量比较,组间差异均无统计学意义[(359.0±65.0)mL,(357.0±58.0)mL,t=1.698,P=0.000;(157.0±41.3)mL,(159.0±40.4)mL,t=-1.829,P=0.068]。术后7 d时常规治疗组1例患者出现股静脉栓塞,加味桃红四物汤组未发现下肢静脉血栓。2组患者的下肢静脉血栓发生率比较,差异无统计学意义(P=1.000)。结论:围手术期应用加味桃红四物汤可有效减少老年股骨转子间骨折PFNA内固定术围手术期隐性失血,并且具有较高的安全性。

Objective：To explore the influence of Jiawei Taohong Siwu Tang（加味桃红四物汤,JWTHSWT） on perioperative hidden blood loss in aged patients who received proximal femoral nail antirotation （PFNA） internal fixation for femoral intertrochanteric fractures and its safety. Methods ： Seventy - eight aged patients with femoral intertrochanteric fractures were randomly divided into JWTHSWT group （38 cases）and conventional therapy group（40 cases）. All patients were treated with PFNA internal fixation by the same group of surgeons and with subcutaneous injection of low - molecular - weight heparin since the 12th hour after the surgery, once a day for consecutive 7 days. Meanwhile, the patients in JWTHSWT group were treated with oral application of JWTHSWT from the 2nd hour after hospitalization admis- sion till postoperative day 7 except on the day of surgery. The blood loss were measured and compared between the 2 groups, and the inci- dences of lower limb venous thrombosis were also observed through ultrasonic examination on postoperative day 7. Results： The total blood loss and postoperative hidden blood loss were lower in JWTHSWT group compared to conventional therapy group （ 1 240.0 ＋/- 297.0 vs 1 475.0 ＋/- 300.0 ml,t = - 124. 637,P = 0.000 ;797.0 ＋/- 290.0 vs 988.0 ＋/- 288.0 ml, t = - 80. 898, P = 0. 000）. There was no sta- tistical difference in dominant blood loss and preoperative hidden blood loss between the 2 groups（359.0 ＋/-65.0 vs 357.0 ＋/-58.0 ml, t = 1. 698, P = 0.000 ; 157.0 ＋/- 41.3 vs 159.0 ＋/- 40.4 ml, t = - 1. 829, P = 0. 068 ）. The femoral venous embolism （ l case） were found on postoperative day 7 in conventional therapy group, and no lower limb venous thrombosis was found in JWTHSWT group. There was no statistical difference in the incidence rate of lower limb venous thrombosis between the 2 groups （P = 1. 000）. Conclusion：Oral application of JWTHSWT in perioperative period can effectively reduce the perioperative hidden blood loss in aged patients who received PFNA internal fixation for femoral intertrochanteric fractures, and it has high safety.