围术期应用氨甲环酸改善老年股骨粗隆间骨折患者PFNA固定隐性失血的临床研究

Clinical study of tranexamic acid in improving hidden blood loss of PFNA fixation in elderly patients with femoral intertrochanteric fractures during perioperative period

目的探讨围术期静脉滴注氨甲环酸(TXA)对改善老年股骨粗隆间骨折患者股骨近端防旋髓内钉(PFNA)固定隐性失血的效果。方法78例行PFNA固定的老年股骨粗隆间骨折患者,根据围术期是否静脉滴注TXA分为对照组(未静脉滴注TXA,40例)和TXA组[静脉滴注TXA,38例]。对比两组围术期血红蛋白(Hb)及红细胞压积(Hct)水平;围术期失血情况[总失血量、显性失血量、隐性失血量、红细胞(RBC)输注量]及输血情况;术后愈合情况及深静脉血栓形成(DVT)发生情况。结果两组患者术前Hb及Hct水平对比,差异无统计学意义(P>0.05);术后1 d及术后3 d,TXA组的Hb及Hct水平均明显高于对照组,差异具有统计学意义(P<0.05)。TXA组围术期总失血量为(604.25±125.43)ml,显性失血量为(90.19±16.04)ml,隐性失血量为(514.06±110.47)ml,RBC输注量为(0.43±0.82)U,均少于对照组的(853.36±225.89)ml、(124.52±32.46)ml、(728.84±194.58)ml、(1.06±1.18)U,差异具有统计学意义(P<0.05);TXA组输血率为21.1%,低于对照组的47.5%,差异具有统计学意义(P<0.05)。两组患者手术切口均甲级愈合。对照组DVT发生率为5.0%(2/40),TXA组DVT发生率为10.5%(4/38),均为肌间静脉丛血栓,两组DVT发生率比较差异无统计学意义(χ^2=0.838,P>0.05)。结论老年股骨粗隆间骨折患者静脉应用TXA可明显减少失血量及输血量,进而减少因贫血而引发的一系列并发症且未见明显不良反应。

Objective To discuss the effect of perioperative intravenous infusion of tranexamic acid(TXA)on improving the hidden blood loss of the proximal femoral nail anti-rotation(PFNA)in elderly patients with femoral intertrochanteric fractures.Methods A total of 78 elderly patients with femoral intertrochanteric fractures undergoing PFNA fixation were divided into control group(without intravenous infusion of TXA,40 cases)and TXA group(intravenous infusion of TXA,38 cases)according to whether TXA was infused intravenously during the perioperative period.The perioperative hemoglobin(Hb)and hematocrit(HCT)levels,perioperative blood loss[total blood loss,dominant blood loss,hidden blood loss,red blood cell(RBC)infusion volume],blood transfusion,postoperative healing and deep venous thrombosis(DVT)were compared between the two groups.Results Before operation,there was no statistically significant difference in Hb and Hct between the two groups(P>0.05).1 and 3 d after operation,Hb and Hct of TXA group were obviously higher than those of the control group,and the difference was statistically significant(P<0.05).The total blood loss during the perioperative period in the TXA group was(604.25±125.43)ml,the dominant blood loss was(90.19±16.04)ml,the hidden blood loss was(514.06±110.47)ml,and RBC infusion was(0.43±0.82)U,which were less than(853.36±225.89)ml,(124.52±32.46)ml,(728.84±194.58)ml and(1.06±1.18)U of the control group,and the difference was statistically significant(P<0.05).The blood transfusion rate of TXA group was 21.1%,which was lower than 47.5%of the control group,and the difference was statistically significant(P<0.05).The surgical incisions of the two groups healed grade A.The incidence of DVT in the control group was 5.0%(2/40),which was 10.5%(4/38)in the TXA group,and the difference was not statistically significant(χ^2=0.838,P>0.05).Conclusion The intravenous use of TXA in elderly patients with femoral intertrochanteric fractures can significantly reduce blood loss and blood transfusion,thereby reducing a series of complications caused by anemia with no obvious adverse reactions.