氨甲环酸对人工关节置换术治疗老年股骨颈骨折围手术期失血的影响

Tranexamic acid reduces blood loss in hip arthroplasty for senile femoral neck fracture

目的探讨术中静脉滴注氨甲环酸对人工关节置换术治疗老年股骨颈骨折围手术期失血的影响。方法回顾性分析2016年1月至2017年8月期间中日友好医院骨科采用人工关节置换术治疗的118例老年股骨颈骨折患者资料。男45例，女73例；平均年龄为77．1岁。根据术中是否使用氨甲环酸分为2组：氨甲环酸组60例，患者接受2次静脉注射，将15mg／kg氨甲环酸溶于100mL生理盐水，滴注时间〉10min，第一剂在切皮前完成，第二剂在关闭切口时使用；对照组58例，仅使用100mL生理盐水。术前1d及术后第1、3天进行血常规检查。记录两组患者输血率、输血量、术中失血量，使用血红蛋白平衡法计算术后第1、3天的总失血量及住院期间并发症情况。结果氨甲环酸组患者的输血率为21．7％，输血量为（310．8±85．7）mL，术中出血量为（424．3±87．6）mL，术后第1天总失血量为（1284．6±288．7）mL，第3天总失血量为（1501．2±337．1）mL，均显著小于对照组患者[41．4％、（379．8±110．2）mL、（526．7±113．8）mL、（1534．8±279．2）mL、（1887．4±431．8）mL]，差异有统计学意义（P〈0．05）。结论人工关节置换治疗老年股骨颈骨折术中使用氨甲环酸，可以降低输血率、减少输血量、减少术中失血量和术后总失血量。使用氨甲环酸也不会增加住院期间血栓等手术并发症的风险。

Objective To investigate the effect of intraoperative dripping of intravenous tranexamic acid （TXA） on the perioperative blood loss in elderly patients undergoing hip arthroplasty for femoral neck fracture. Methods From January 2016 to August 2017, 118 elderly patients with femoral neck fracture were treated with hip arthroplasty at Department of Orthopaedics, China-Japan Friendship Hospital. They were 45 males and 73 females, with an average age of 77.1 years. Of them, 60 （TXA group） were subjected to intravenous TXA dripping over 10 minutes by 2 doses （15 mg/kg TXA dissolved in 100 mL of saline） with the first dose before incision and the second one at wound closure; 58 （control group） were subjected to intravenous administration of 100 mL of saline solution in a similar fashion. Blood routine tests were carried out one day before operation, and the first and third days after operation. The transfusion rate and volume, and surgical blood loss were recorded. The total blood loss on postoperative 1-day and 3-day were calculated according to hemoglobin balance method. The 2 groups were compared in terms of blood loss and complications. Results The blood transfusion rate （21.7%）, blood transfusion volume （310.8 ± 85.7 mL）, surgical blood loss （424. 3 ± 87.6 mL）, total blood loss on postoperative 1-day （1,284. 6± 288.7 mL） and total blood loss on postoperative 3-day （1,501.2±337. 1 mL） in the TXA group were all significantly lower than those in the control group （41.4%, 379.8 ±110.2 mL, 526. 7 ± 113.8 mL, 1, 534. 8±279.2 mL and 1,887.4±431.8 mL, respectively） （P 〈0. 05）. There was no significant difference between the 2 groups in postoperative complications （ P 〉 0. 05）. Conclusion In el- derly patients undergoing hip arthroplasty for femoral neck fracture, intravenous TXA administration may lower transfusion rate, reduce transfusion volume, and decrease surgical blood loss and postoperative total blood loss without increasing the risks of surgery-related complications like thrombosis.