股骨髓腔注射氨甲环酸对股骨粗隆间骨折围术期失血的影响

Effect of tranexamic acid injection in femoral bone marrow cavity on perioperative blood loss in patients with femoral intertrochanteric fracture

目的探究股骨髓腔注射氨甲环酸(TXA)对股骨粗隆间骨折患者围术期失血的影响。方法前瞻性选取我院收治的108例股骨粗隆间骨折患者,按随机数字表法将其分为对照组(n=54)和观察组(n=54)。对照组在扩髓前静脉滴注TXA,观察组在对照组的基础上于开髓后髓腔内注射TXA。比较两组手术中的输血量、输血率;隐性、显性及围术期总失血量;术前及术后5 d凝血指标;术后24 h引流量。结果两组均随访2~6个月,统计随访期间两组下肢深静脉血栓、肺栓塞等并发症发生情况。观察组术中输血量、输血率、术后24 h引流量、隐性、显性及围术期总失血量[(0.31±0.09)U、11.11%、(198±101)ml、(528±157)ml、(375±103)ml、(892±232)ml]均少于对照组[(0.49±0.13)U、29.63%、(495±123)ml、(843±237)ml、(469±144)ml、(1309±372)ml](P<0.05);与术前相比,两组术后5 d APTT水平均升高,且观察组APTT水平[(32.64±5.96)s]低于对照组[(37.52±6.17)s](P<0.05);术后5 d对照组的PT水平[(12.87±2.32)s]较术前升高[(15.49±2.82)s],且观察组[(12.87±2.32)s]显著低于对照组(P<0.05);两组术前及术后3 d的INR差异无统计学意义(P>0.05);随访期间,两组患者下肢深静脉血栓发生率差异无统计学意义(P>0.05),均未发生肺栓塞。结论股骨髓腔注射TXA可有效减少股骨粗隆间骨折患者PFNA内固定术围手术期失血量,且不增加术后下肢深静脉血栓及肺栓塞形成的风险。

Objective To explore effect of tranexamic acid injection in femoral bone marrow cavity on perioperative blood loss in patients with femoral intertrochanteric fracture.Methods 108 patients of intertrochanteric fracture admitted to our hospital were selected,they were divided into control group(n=54)and observation group(n=54)according to the random number table method.TXA was infused into the veins of the control group before the reaming,and the observation group was injected with TXA in the medullary cavity after the operation.Intraoperative blood transfusion volume,blood transfusion rate in the two groups were compared;The recessive,dominant and perioperative total blood loss in the two groups were compared;The coagulation indexes were compared before and 5 days after operation in the two groups;the drainage volume at 24 hours after operation was compared in the two groups,both groups were followed up for 2-6 months,the incidence of complications such as deep vein thrombosis and pulmonary embolism in the two groups during the follow-up period was calculated.Results In the observation group,the intraoperative blood transfusion volume,blood transfusion rate,24 hours postoperative blood flow,recessive,dominant and perioperative total blood loss[(0.31±0.09)U,11.11%,(198±101)ml,(528±157)ml,(375±103)ml,(892±232)ml]were less than those in the control group[(0.49±0.13)U,29.63%、(495±123)ml,(843±237)ml,(469±144)ml,(1309±372)ml](P<0.05).Compared with before surgery,5 days after surgery,the APTT levels in the two groups increased,and the APTT level in the observation group[(32.64±5.96)s]was lower than that in the control group[(37.52±6.17)s](P<0.05);the PT level of the control group[(12.87±2.32)s]on day 5 after the operation was higher than that before the operation[(15.49±2.82)s],and the observation group[(12.87±2.32)s]was significantly lower than the control group(P<0.05),there was no significant difference in INR between the two groups before and 3 days after the operation(P>0.05).During follow-up,there was no significant difference in the incidence of deep vein thrombosis of the lower extremities between the two groups after operation(P>0.05),and no pulmonary embolism occurred.Conclusion Femoral medullary injection of TXA can effectively reduce perioperative blood loss in patients with intertrochanteric fractures during PFNA internal fixation,increasing hemoglobin and hematocrit levels,reducing invisible blood loss,without increasing the risk of deep vein thrombosis and pulmonary embolism after surgery.