氨甲环酸与肾上腺素局部注射对不稳定性股骨转子间骨折病人围术期失血量及凝血因子水平的影响

Effects of local injection of tranexamic acid and epinephrine combined with intravenous infusion of tranexamic acid on perioperative blood loss and coagulation factors levels in patients with unstable femoral intertrochanteric fractures

目的探讨氨甲环酸(tranexamic acid,TXA)静滴联合TXA与肾上腺素局部注射对不稳定性股骨转子间骨折病人围术期失血量及凝血因子水平的影响。方法选取2016年12月至2019年12月在平煤神马医疗集团总医院采用股骨近端防旋髓内钉治疗的老年不稳定性股骨转子间骨折病人80名做为研究对象。随机将病人分为观察组(n=40),对照组(n=40)。对照组术前30 min静脉滴注TXA,观察组在对照组基础上,术中扩髓前给予TXA、肾上腺素打入髓腔。记录两组显性、隐性以及围手术期的总失血量,术后需输血病例数,最大血红蛋白丢失量,手术前后血红蛋白、血细胞比容、纤维蛋白原(FIB)、D-二聚体(DD)水平,术后90 d内深静脉血栓(deep vein thrombosis,DVT)、肺栓塞(pulmonar embolism,PE)等并发症发生情况。结果两组病人手术隐性失血量[(455.44±62.34)mL比(596.78±65.91)mL]、围手术期总失血量[(620.78±112.67)mL比(760.15±108.46)mL]、输血病例数[12比25],以及最大血红蛋白丢失量[(14.48±3.44)g比(27.47±4.52)g]、手术后血红蛋白[(109.27±11.28)g/L比(98.82±13.46)g/L]和血细胞比容[(34.48±3.29)%比(29.26±3.31)%]对比,差异有统计学意义(P<0.05);手术后7 d两组FIB、D-D相比差异有统计学意义(P<0.05);两组病人术后并发症发生率未见差异(P>0.05)。结论TXA静滴联合TXA与肾上腺素局部注射可明显降低股骨近端防旋髓内钉治疗的老年不稳定性股骨转子间骨折病人围手术期失血量,且不增加术后DVT、PE等并发症发生率,值得推广与运用。

Objective To investigate the effects of intravenous infusion of tranexamic acid(TXA)combined with local injection of TXA and epinephrine on perioperative blood loss and levels of coagulation factors in patients with unstable femoral intertrochanteric fractures.Methods A total of 80 elderly patients with unstable femoral intertrochanteric fractures who were treated with proximal femoral nail anti-rotation in General Hospital of Pingmei Shenma Group between December 2016 and December 2019 were selected as the research subjects,and they were randomly divided into observation group(n=40)and control group(n=40).The control group received intravenous infusion of TXA at 30 minutes before surgery.On the basis of the control group,the observation group was given TXA and epinephrine into the medullary cavity before intraoperative marrow reaming.The dominant blood loss,recessive blood loss and perioperative total blood loss,the number of cases requiring blood transfusion after surgery,the maximum hemoglobin loss,levels of hemoglobin,hematocrit,fibrinogen(FIB)and D-Dimer(D-D)before and after surgery,and occurrence of complications such as deep vein thrombosis(DVT)and pulmonary embolism(PE)within 90 days after surgery were recorded in the two groups.Results There were statistically significant differences between the two groups in terms of recessive blood loss[(455.44±62.34)mL vs.(596.78±65.91)mL],total blood loss during perioperative period[(620.78±112.67)mL vs.(760.15±108.46)mL],the number of cases with blood transfusion(12 vs.25),maximum hemoglobin loss[(14.48±3.44)g vs.(27.47±4.52)g],postoperative hemoglobin[(109.27±11.28)g/L vs.(98.82±13.46)g/L]and postoperative hematocrit[(34.48±3.29)%vs.(29.26±3.31)%](P<0.05).The differences in the levels of FIB and D-D were statistically significant between the two groups at 7 days after surgery(P<0.05).There were no significant differences in incidence rates of postoperative complications between the two groups(P>0.05).Conclusion Intravenous infusion of TXA combined with local injection of infusion of and epinephrine can significantly reduce the perioperative blood loss of elderly patients with unstable femoral intertrochanteric fractures treated by proximal femoral nail anti-rotation,and the treatment regimen does not increase the incidence rates of postoperative DVT,PE and other complications,thus it is worthy of promotion and application.