氨甲环酸不同给药途径对接受手术治疗的老年股骨粗隆间骨折患者的临床研究

Clinical study of different administration routes of tranexamic acid in surgical treatment of elderly patients with femoral intertrochanteric fracture

目的 研究氨甲环酸不同给药途径对接受闭合复位股骨近端防旋髓内钉(PFNA)内固定术治疗的老年股骨粗隆间骨折患者围术期失血情况,以及血红蛋白(Hb)、红细胞压积(HCT)水平的影响。方法 选取2020年6月至2022年5月期间安徽医科大学附属巢湖医院收治的122例老年股骨粗隆间骨折患者,均行闭合复位PFNA内固定术治疗,根据随机数字表法将患者分为对照组(33例,不使用氨甲环酸)、术中局部给药组(32例,术中局部应用氨甲环酸)、术前静脉给药组(26例,术前30 min静脉滴注氨甲环酸)、联合给药组(31例,术中局部联合术前静脉应用氨甲环酸)。比较4组患者显性出血量、总失血量、隐性失血量及手术时间,术前及术后1、3、5 d Hb、HCT水平。结果 与对照组比,术中局部给药组、术前静脉给药组、联合给药组患者显性出血量、总失血量、隐性失血量均显著减少,且联合给药组上述指标均显著低于术前静脉给药组、术中局部给药组;与术前比,术后1~5 d 4组患者Hb、HCT水平均显著降低,与对照组比,术后各时间点术中局部给药组、术前静脉给药组、联合给药组患者Hb、HCT水平均显著升高,但联合给药组显著高于术中局部给药组、术前静脉给药组(均P<0.05)。术中局部给药组、术前静脉给药组患者显性出血量、总失血量、隐性失血量及术后1~5 d Hb、HCT水平,4组患者手术时间、术后1个月血栓发生率比较,差异均无统计学意义(均P>0.05)。结论 氨甲环酸采用术中局部与术前静脉联合的给药方式应用于老年股骨粗隆间骨折患者手术中,可发挥良好的止血效果,同时对血液系统影响较小,可预防血栓、贫血的发生。

Objective To investigate the effects of different administration routes of tranexamic acid on perioperative blood loss,and hemoglobin(Hb)and hematocrit(HCT)levels in elderly patients with femoral intertrochanteric fracture treated undergoing closed reduction and proximal femoral nail anti-rotation(PFNA)internal fixation.Methods A total of 122 elderly patients with femoral intertrochanteric fracture admitted to Chaohu Hospital of Auhui Medical University from June 2020 to May 2022 were selected,all patients were treated with closed reduction and PFNA internal fixation,according to the random number table method,patients were divided into the control group(33 cases,didn’t applied tranexamic acid),the intraoperative local administration group(32 cases,locally applied tranexamic acid during operation),the preoperative intravenous administration group(26 cases,injected intravenously tranexamic acid 30 min before the operation),and the combined administration group(31 cases,locally applied during operation combined with preoperative intravenous administration of tranexamic acid).The dominant blood loss,total blood loss,recessive blood loss,operation time,and the levels of Hb and HCT before and 1,3,5 d after operation were compared among the 4 groups.Results Compared with the control group,the dominant blood loss,total blood loss and recessive blood loss significantly reduced in the intraoperative local administration group,preoperative intravenous administration group and combined administration group,and the above indexes in the combined administration group were significantly lower than those in the preoperative intravenous administration group and the intraoperative local administration group;compared with before operation,the levels of Hb and HCT of patients in the 4 groups decreased significantly from 1 to 5 days after operation,compared with the control group,the levels of Hb and HCT of patients in the intraoperative local administration group,the preoperative intravenous administration group and the combined administration group increased significantly at each time point after operation,but the combined administration group was significantly higher than the intraoperative local administration group and the preoperative intravenous administration group(all P<0.05).There was no statistically significant difference in the dominant blood loss,total blood loss and recessive blood loss of patients,the level of Hb and HCT from 1 to 5 days after operation of patients between the local administration group and the intravenous administration group,and the operation time,the incidence of thrombus 1 month after operation of patients among the 4 groups(all P>0.05).Conclusion Tranexamic acid applied in the operation of elderly patients with femoral intertrochanteric fracture by the combination of intraoperative local administration and preoperative intravenous,which can play a good hemostatic effect,and has little influence on the blood system,so as to prevent the occurrence of thrombosis and anemia.