局部应用氨甲环酸对老年股骨转子间骨折患者术后失血量的影响

Effect of local application of tranexamic acid on postoperative blood loss in aged patients with femoral intertrochanteric fractures

目的:探讨局部应用氨甲环酸对老年股骨转子间骨折患者术后失血量的影响及其安全性。方法:将符合入选标准的60例老年股骨转子间骨折患者随机分为氨甲环酸组(30例)与生理盐水组(30例)。60例患者均行闭合复位股骨近端防旋髓内钉内固定治疗,术中在关闭近端切口前,氨甲环酸组将1 g氨甲环酸溶入20 m L生理盐水中,注射于大腿近端外侧骨折部位周围深筋膜下方;生理盐水组于相同部位注射等量的生理盐水。术后第1、第3、第5天复查血常规,以术后第5天的检测结果计算失血量。总失血量=术前血容量×(术前红细胞压积-术后第5天红细胞压积);术中失血量=术中吸引瓶液体量-冲洗液量+纱布增加的质量;术后失血量=总失血量-术中失血量+输血量。记录2组患者总失血量、术后失血量、输血例数、输血量及术后血红蛋白含量下降值(术前血红蛋白含量检测值-术后第1天血红蛋白含量检测值),观察下肢深静脉血栓形成、肺栓塞等并发症发生情况。结果:2组患者均顺利完成手术。氨甲环酸组总失血量、术后失血量、输血量、术后血红蛋白含量下降值均低于生理盐水组[(410.9±65.2)m L,(565.4±72.8)m L,t=8.659,P=0.000;(326.0±75.9)m L,(392.2±81.4)m L,t=3.258,P=0.002;(70.5±146.5)m L,(190.4±151.6)m L,Z=-4.073,P=0.000;(16.2±8.1)g·L^(-1),(25.1±5.4)g·L^(-1),t=5.007,P=0.000];氨甲环酸组输血2例,生理盐水组输血8例,氨甲环酸组输血患者的比例小于生理盐水组(χ~2=4.320,P=0.038)。2组患者均未发现下肢深静脉血栓形成、肺栓塞、感染及皮肤坏死等并发症。结论:闭合复位股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折,术中局部应用氨甲环酸可有效减少患者术后失血量,且无增加下肢深静脉血栓形成、肺栓塞等并发症发生的风险,安全性高。

Objective ：To explore the effect of local application of tranexamic acid on postoperative blood loss in aged patients with femoral intertrochanteric fractures and its safety. Methods ： Sixty aged patients with femoral intertrochanteric fractures who met the inclusion criteria were randomly divided into tranexamic acid group and normal saline （ NS） group, 30 cases in each group. All patients were treated with closed reduction and proximal femoral nail anti - rotation（ PFNA） internal fixation. The tranexamic acid（ 1 g） ,dissolved in normal sa-line （20 mL） ,were injected into the space underneath the deep fascia around the lateral fractured sites of proximal thighs before the incision was sutured in tranexamic acid group,and the same dose of NS were injected into the same region in NS group. The routine blood test was performed on the 1st,3rd and 5th day after surgery respectively,and the blood loss was calculated according to the examination results ob-tained on the 5 th day after surgery. The total blood loss was calculated by multiplying the preoperative blood volume by the difference be-tween preoperative hematokrit and postoperative day 5 hematokrit. The intraoperative blood loss was calculated by subtracting the volume of rinse solution from the volume of intraoperative liquid in suction bottle and plusing the increased mass of carbasus. The postoperative blood loss was calculated by subtracting the intraoperative blood loss from the total blood loss and plusing the blood transfusion volume. Total blood loss, postoperative blood loss, blood transfusion rate, blood transfusion volume and postoperative decreased values of hemoglobin （HGB） content（ difference in HGB content between pre - surgery and postoperative day 1 ） were recorded and compared between the 2 groups,and the complications such as lower extremity deep venous thrombosis（ DVT）and pulmonary embolism were observed. Results： The surgeries were finished successfully in all patients. Total blood loss,postoperative blood loss,blood transfusion volume and postoperative de-creased values of HGB content were lower in tranexamic acid group compared to NS group（410. 9 ＋/- 65. 2 vs 565. 4 ＋/- 72. 8 mL, t = 8.659,P=0.000; 326.0 ＋/ -75.9 vs 392. 2 ＋/ -81.4 mL^ = 3. 258 = 0. 002 ; 70. 5 ＋ /-1 4 6 .5 vs 190.4 ＋ /-1 5 1 .6 mL,Z = -4 .0 7 3 ,P =0. 000; 16. 2 ＋/- 8. 1 vs 25. 1 ＋/-5.4 g /h , t = 5. 007 ,P = 0. 000） . Blood transfusions were performed in tranexamic acid group（2） and NS group（ 8 ） , and the blood transfusion rate was smaller in tranexamic acid group compared to NS group（x^2 = 4. 320 ,P =0. 038 ） . No com-plications such as lower extremity DVT, pulmonary embolism, infection and cutaneous necrosis were found in the 2 groups. Conclusion ： Lo-cal application of tranexamic acid can effectively reduce postoperative blood loss in aged patients who receive PFNA internal fixation for treatment of femoral intertrochanteric fractures, and it has high safety considering it does not increase the risk of complications such as lower extremity DVT and pulmonary embolism.