氨甲环酸对髋部骨折患者围手术期失血量的影响及安全性研究

Effect and Safety of Tranexamic Acid on Perioperative Blood Loss in Patients with Hip Fracture

目的:探讨氨甲环酸对不同类型髋部骨折患者围手术期失血量的影响,评估其在临床治疗中的有效性及安全性。方法:选取2017年6月至2019年6月于成飞医院就诊的髋部骨折行手术治疗的146例患者作为研究对象,其中股骨粗隆间骨折60例,股骨颈骨折50例,髋臼骨折36例。将以上患者采用信封法分为氨甲环酸组和对照组。氨甲环酸组患者在手术切皮前15 min内静脉滴注氨甲环酸1 g,关闭切口前软组织多层点状浸润注射氨甲环酸1 g;对照组患者在相同条件下给予同部位等剂量的0.9%氯化钠注射液。观察两组患者术中出血量、术后引流量、隐性失血量、显性失血量和输血率等指标的变化。结果:(1)股骨粗隆间骨折,氨甲环酸组患者隐性失血量较对照组明显减少,差异有统计学意义(P<0.05);而术中出血量、术后第1日引流量和术后第2日引流量与对照组相比,差异均无统计学意义(P>0.05)。(2)股骨颈骨折,与对照组相比,氨甲环酸组患者术后第1日引流量和隐性失血量明显减少,差异均有统计学意义(P<0.05或P<0.01);而两组患者术中出血量的差异无统计学意义(P>0.05)。(3)髋臼骨折,氨甲环酸组患者术中出血量、显性失血量、隐性失血量及术后第1、2日引流量均较对照组明显减少(P<0.05或P<0.01)。(4)氨甲环酸组股骨粗隆间骨折、股骨颈骨折及髋臼骨折患者的输血率均明显低于对照组,差异均有统计学意义(P<0.05)。(5)两组患者均无不良血栓事件发生。结论:氨甲环酸可有效减少髋部骨折患者围手术期失血量,对髋部骨折患者临床安全治疗奠定了基础。

OBJECTIVE:To probe into the effect of tranexamic acid on perioperative blood loss in patients with different types of hip fracture,so as to evaluate its effectiveness and safety in clinical treatment.METHODS:Totally 146 patients with hip fracture undergoing surgery admitted into Chengfei Hospital from Jun.2017 to Jun.2019 were selected,including 60 patients with femoral intertrochanteric fracture,50 patients with femoral neck fracture and 36 patients with acetabulum fracture.All the patients were divided into tranexamic acid group and control group via envelope method.The tranexamic acid group was given 1 g of tranexamic acid for intravenous infusion within 15 minutes before surgical incision,and given 1 g of tranexamic acid for multi-layered punctate infiltration in soft tissue before incision closure;the control group was given 0.9%sodium chloride injection in the same dose at the same site.Changes in intraoperative blood loss,postoperative drainage,recessive blood loss,dominant blood loss and blood transfusion rate of both groups were observed.RESULTS:(1)femoral intertrochanteric fracture:the recessive blood loss of tranexamic acid group was significantly less than that of the control group,with statistically significant difference(P<0.05);while there was no statistical significance in differences in intraoperative blood loss,drainage at the first and second day after surgery between tranexamic acid group and control group(P>0.05).(2)femoral neck fracture:compared with the control group,the drainage at the first day after surgery and recessive blood loss were significantly less,with statistically significant differences(P<0.05 or P<0.01);there was no statistical significance in difference in intraoperative blood loss between two groups(P>0.05);(3)acetabulum fracture:the intraoperative blood loss,recessive blood loss,dominant blood loss,drainage at the first and second day after surgery of tranexamic acid group were significantly less than those of the control group(P<0.05 or P<0.01).(4)the blood transfusion rates of patients with femoral intertrochanteric fracture,femoral neck fracture and acetabulum fracture in tranexamic acid group were significantly lower than those of the control group,with statistically significant differences(P<0.05).(5)there was no adverse thrombus events occurred in both groups.CONCLUSIONS:Tranexamic acid can significantly reduce intraoperative blood loss in patients with hip fracture,which laid the foundation for the safe treatment of patients with hip fractures.