氨甲环酸减少高龄股骨颈骨折半髋关节置换术失血的观察

Tranexamic Acid in Reducing Blood Loss in Hemiarthroplasty for Femoral Neck Fracture in the Elderly

目的探索在高龄股骨颈骨折患者行人工半髋关节置换手术前,静脉使用氨甲环酸的安全性和作用。方法选取2016年6月-2017年5月期间在华东医院骨科进行人工半髋关节置换手术的高龄股骨颈患者58例,随机分为2组:观察组和对照组,每组29例。观察组患者在手术开始前按照15mg/kg体重静脉滴注氨甲环酸;对照组患者静脉滴注等量的生理盐水。评估并比较2组术中失血量、术后引流量、隐性失血量、凝血酶原时间(PT)和活化部分凝血酶原时间(APTT);观察并比较2组术后输血的比例以及下肢静脉血栓和肺栓塞的等不良事件的发生情况。结果 2组术中失血量、术后引流量以及隐形失血量差异均有统计学意义(P<0.05),而PT与APTT差异均无统计学意义(P>0.05);术后1周内,观察组输血3例,对照组输血6例,需要输血的比例差异有统计学意义(P<0.05);2组于术后1周复查下肢B超,每组发现2例肌间静脉血栓,差异无统计学意义(P>0.05);2组均无肺栓塞发生。结论按照15mg/kg体重剂量静脉使用氨甲环酸在高龄股骨颈骨折半髋关节置换手术中可以减少患者术中出血,减少术后引流,并降低隐形失血,降低术后输血的概率,且不造成凝血指标改变,不增加深静脉血栓和肺栓塞发生风险。

Objective To investigate the clinical effect and safety of intravenous drip of tranexamic acid(TXA) before hemiarthroplasty in the elderly with femoral neck fracture.Methods 58 elderly with femoral neck fracture undergoing hemiarthroplasty during the period from June,2016 to May,2017 were randomly divided into 2 groups:observation group and control group,29 in each;before operation start,intravenous drip of TXA at the dosage of 1 5 mg/kg was made to the cases in observation group while intravenous drip of saline at the same velocity to those in control group;the volumes of intra-operative blood loss,postoperative drainage,hidden blood loss,the lenth of prothrombin time(PT) and activated partial thromboplastin time(APTT) of the cases were observed and a comparative study was made between the 2 groups.Results There were statistical differences in the volumes of intra-operative blood loss,postoperative drainage and hidden blood loss(P<0.05) and the difference in PT,APTT between the 2 groups was of no statistical significance(P>0.05);1 week after operation,3 cases in observation and 6 cases in control group received blood transfusion,the difference in blood transfusion between the 2 groups was of statistical significance(P>0.05);ultrasonic re-examination of lower limbs 1 week after operation found intramuscular venous thrombosis in 2 cases in each group(P<0.05);no occurrence of pulmonary embolism was found in both groups.Conclusions Intravenous drip of TXA at the dosage of 1 5 mg/kg in hemiarthroplasty for femoral neck fracture in the elderly can reduce the intra-operative blood loss,post-operative drainage volume,hidden blood loss,the probability of postoperative blood transfusion without changing the levels of PT and APTT and raising the risk of the occurrence of venous thrombosis and pulmonary embolism.