氨甲环酸对老年股骨转子间骨折PFNA术后隐性失血的治疗效果及预后价值观察

Treatment effects and prognostic value of tranexamic acid on hidden blood loss after PFNA in elderly femoral intertrochanteric fractures

目的探究氨甲环酸对行股骨近端防旋髓内钉(proximal femoral nail fixation,PFNA)术的老年股骨转子间骨折患者术后隐性失血疗效及预后的影响。方法选取2017年10月至2018年10月于本院行PFNA术的92例老年股骨转子间骨折患者作为研究对象,按照入院顺序随机分为研究组与对照组,各46例。对照组予以0.9%氯化钠注射液治疗,研究组给予氨甲环酸治疗。比较两组患者术后隐性失血量、术前及术后3、7 d血红蛋白水平、7 d后凝血功能[活化部分凝血酶时间(APTT)、凝血酶原时间(PT)]水平及下肢深静脉血栓形成情况。结果术后,研究组隐性失血量明显低于对照组;术后3、7 d,两组血红蛋白水平较术前显著下降,但研究组下降幅度小于对照组;术后7 d,研究组APTT、PT水平较术前均有所下降,且低于同期对照组(P<0.05)。术后7 d,两组患者下肢深静脉血栓发生率比较差异无统计学意义。结论氨甲环酸能够有效降低老年股骨转子间骨折患者行PFNA术后隐性失血水平,减小血红蛋白水平下降幅度,且安全性较高。

Objective To explore the effects of tranexamic acid on efficacy and prognosis of postoperative hidden blood loss in elderly patients with femoral intertrochanteric fractures treated by proximal femoral nail fixation(PFNA).Methods A total of 92 elderly patients with femoral intertrochanteric fractures who underwent PFNA in the hospital from October 2017 to October 2018 were selected as study subjects,and they were randomly divided into study group and control group according to admission sequence,with 46 cases in each group.Control group was treated with 0.9%sodium chloride injection,and study group was treated with tranexamic acid.The postoperative hidden blood loss,hemoglobin level before operation and at 3,7 d after operation,and coagulation function[activated partial thromboplastin time(APTT),prothrombin time(PT)]and formation of lower extremity deep venous thrombosis were compared between the two groups after 7 d.Results After operation,the amount of hidden blood loss in study group was significantly lower than that in control group.The hemoglobin levels in the two groups at 3 d and 7 d after operation were significantly lower than those before operation,but the decreases in study group were smaller than those in control group.At 7 d after operation,the APTT and PT in study group were lower than those before operation and were lower than those in control group at the same period(P<0.05).There was no significant difference in the incidence rate of lower extremity deep venous thrombosis between the two groups.Conclusion Tranexamic acid can effectively reduce the level of hidden blood loss after PFNA in elderly patients with femoral intertrochanteric fractures,and reduce the decrease of hemoglobin level,and it has high safety.