氨甲环酸腔内注射对股骨粗隆间骨折闭合髓内钉内固定潜在失血量的影响

Effect on recessive blood loss of intraluminal injection of tranexamic acid in femoral intertrochanteric fractures with closed intramedullary nail for internal fixation

目的探究氨甲环酸对于股骨粗隆间骨折闭合髓内钉(Inter Tan)内固定潜在失血的临床疗效和安全性。方法选择2014年6月至2016年6月安徽医科大学附属巢湖医院接受股骨粗隆间骨折髓内钉内固定手术治疗的100例患者为研究对象,分层随机分为对照组和观察组(各50例)。其中对照组在手术扩髓后给予0.9%氯化钠溶液250 m L腔内注射;观察组则以250 m L的氨甲环酸溶液腔内注射。比较两组患者手术前后的血红蛋白变化以及输血情况;手术过程中的可见失血量、潜在失血量和总失血量;并在术后利用超声检查下肢深静脉血栓形成情况。结果两组患者术前血红蛋白差异无统计学意义(P>0.05);观察组患者术后连续3 d的血红蛋白含量均高于对照组;观察组19例患者需行输血,而对照组32例需要输血;观察组输血量为(228.95±60.82)m L,明显少于对照组(P<0.01);两组患者在可见失血量方面差异无统计学意义[(155.20±17.87)m L比(156.80±10.39)m L,P>0.05],但观察组患者的潜在失血量[(794.09±234.19)m L比(1 094.7±269.3)m L]和总失血量[(950.89±237.54)m L比(1 249.9±270.03)m L]均明显少于对照组(P<0.01);术后两组均未出现下肢深静脉血栓。结论临床上使用氨甲环酸对髓内钉内固定潜在失血的临床疗效明显,显著降低患者的失血量,并且具有较高的安全性,因此值得应用和推广。

Objective To investigate the clinical efficacy and safety of Tranexamic acid in the treatment of hidden blood loss after intertrochanteric interlocking intramedullary nail（Inter Tan） internal fixation. Methods A total of 100 patients who underwent intramedullary nail fixation for intertrochanteric fractures from June 2014 to June 2016 in Chaohu Affiliated Hospital of Anhui Medical University were randomly assigned into control group and observation group（50 cases for each group）. The control group was given 250 m L,0. 9%Na Cl solution injection after marrow expanding. The observation group was injected with 250 m L Tranexamic acid solution. The changes of hemoglobin and blood transfusion before and after operation,the amount of dominant blood loss,hidden blood loss and total blood loss during operation were compared between the two groups. Ultrasound was used to check the deep vein thrombosis of the lower limbs after operation. Results Levels of hemoglobin before operation in two groups was not significantly different（P 〉 0. 05）. Hemoglobin of the observation group was higher than control group after operation for 3 consecutive days. In the observation group,19 patients were transfused and 32 cases in the control group needed blood transfusion. The content of the blood transfasion was（228. 95 ± 60. 82） m L,which was significantly lower in the observation group than that in the control group（P 〈 0. 01）. There was no significant difference in dominant blood loss between two groups [（155. 20 ± 17. 87） m L vs（156. 80 ± 10. 39） m L,P 〉 0. 05 ],but the amounts of hidden blood loss[（794. 09 ± 234. 19） m L vs（1 094. 7 ± 269. 3） m L] and total blood loss[（950. 89 ± 237. 54） m L vs（1 249. 9 ± 270. 03）m L] were significantly lower in the observation group than in the control group;the differences between two groups were statistically significant（P 〈 0. 01）. No deep venous thrombosis of the lower extremities occurred in both groups. Conclusions Tranexamic acid is effective in the treatment of hidden blood loss after intertrochanteric interlocking intramedullary nail internal fixation,significantly reduce the amount of blood loss in patients,and has a high safety,therefore worthy of application and promotion.