跟骨骨折手术治疗中局部联合静脉应用氨甲环酸的疗效观察

Curative effect of local combined with intravenous tranexamic acid in surgical treatment of calcanealfracture

目的探讨跟骨骨折手术治疗过程中局部联合静脉应用氨甲环酸(Tranexamic acid,TXA)的疗效及安全性。方法将2018年12月至2019年11月西安交通大学医学院附属红会医院收治的38例跟骨骨折病人(均为单侧)按照就诊顺序分成观察组和对照组,观察组20例,对照组18例。观察组病人手术开始后静脉点滴TXA(15 ml/kg),并在松止血带前5~10 min局部灌注TXA(15 ml/kg);对照组病人在手术开始后以及松止血带前5~10 min分别通过静脉点滴、局部灌注的方式应用生理盐水(15 ml/kg)。记录并比较两组病人的术中失血量、术后失血量、术后48 h引流量、术前术后纤维蛋白降解产物(fibrin deg⁃radation products,FDP)、血红蛋白(Hb)、D-二聚体(D⁃dimer)、围手术期静脉血栓性疾病以及术后伤口并发症情况。结果38例病人中37例病人术后伤口一期愈合。观察组病人术中失血量、术后失血量、术后第1天Hb、术后48 h引流量、术后24 h D⁃dimer、术后24 h FDP、术后72 h FDP分别为[(79.50±12.98)ml、(202.65±36.75)ml、(111.45±10.52)g/L、(189.90±15.43)ml、(4.25±1.85)mg/L、(3.31±1.09)mg/L、(3.11±1.03)mg/L],对照组为[(93.72±10.72)ml、(313.50±54.59)ml、(104.05±11.07)g/L、(252.28±32.67)ml、(6.01±2.59)mg/L、(4.65±1.87)mg/L、(4.22±1.71)mg/L];观察组术后伤口红肿渗出1例,对照组6例,以上指标两组比较,观察组均优于对照组,差异均有统计学意义(P均<0.05)。两组病人术后下肢深静脉血栓形成率以及术后伤口皮缘坏死情况比较,差异无统计学意义(P>0.05)。结论对于跟骨骨折手术治疗的病人,局部联合静脉应用TXA可以减少围手术期失血、术后引流量,降低术后伤口并发症的发生率且不会增加发生血栓性疾病的风险。

Objective To investigate the efficacy and safety of local combined with intravenous application of tranexamic acid(TXA)in the surgical treatment of calcaneal fractures.Methods Thirty⁃eight patients with calcaneal fractures(all unilateral)admitted to the Honghui Hospital Affiliated to Medicine College of Xi’an Jiaotong University from December 2018 to November 2019 were divided into two groups according to the order of visits,including 20 in the observation group,and 18 in the control group.Patients in the observation group were given intravenous drip of TXA(15 ml/kg)after the start of the operation and local perfusion of TXA(15 ml/kg)5⁃10 min before the tourniquet was loosened,and those in the control group were intravenously dripped and locally infused with saline(15 ml/kg)after the start of the operation and 5⁃10 min before the tourniquet was loosened.The intraoperative blood loss,postoperative blood loss,postoperative 48 h drainage volume,preoperative and postoperative fibrin degradation products(FDP),hemoglobin(Hb),D⁃dimer,perioperative venous thrombotic disease and postoperative wound complications were recorded and compared between the two groups.Results Thirty⁃seven patients healed in one stage.Intraoperative blood loss,postoperative blood loss,Hb on the first day after operation,drainage volume 48 h after operation,postoperative 24⁃h D⁃dimer, postoperative 24⁃h FDP, postoperative 72⁃h FDP in the observation group were (79.50±12.98) ml,(202.65±36.75) ml, (111.45±10.52) g/L, (189.90±15.43) ml, (4.25±1.85) mg/L, (3.31±1.09) mg/L, (3.11±1.03) mg/L,and those in the control group were (93.72±10.72) ml, (313.50±54.59) ml, (104.05±11.07) g/L, (252.28±32.67)ml, (6.01±2.59) mg/L, (4.65±1.87) mg/L, (4.22±1.71) mg/L, respectively. There was 1 case of postoperativewound swelling and exudation in the observation group and 6 cases in the control group. All the differenceswere statistically significant between groups (P<0.05). There was no significant difference in the rate of deepvein thrombosis of the lower extremities and necrosis of the wound skin between the two groups (P>0.05).Conclusion Local combined with intravenous application of TXA for patients with calcaneal fracture surgerycan reduce perioperative blood loss, postoperative drainage, and the incidence of postoperative woundcomplications without increasing the risk of thrombotic disease.