氨甲环酸的不同应用方式对跟骨骨折术后引流量的影响

The influence of different ways of application of tranexamic acid on the postoperative drainage of calcaneus fracture

目的观察氨甲环酸(tranexamic acid,TXA)的不同应用方式对跟骨骨折术后引流量的影响。方法选取2017年7月至2019年7月大连医科大学附属大连市第三人民医院收治的SandersⅢ~Ⅳ型闭合性跟骨骨折患者90例,依据处理方式不同分为3组,每组30例,分别为A组(术前10 min静脉点滴氨甲环酸15 mg/kg加术中局部外用氨甲环酸100 ml)、B组(术前10 min静脉点滴0.9%NaCl及术中外用氨甲环酸100 ml)和C组(术前10 min静脉点滴0.9%NaCl)。比较3组术后24 h及48 h时的失血量、术后凝血酶原时间和术后活化部分凝血活酶时间、术后血红蛋白及红细胞比容等数值。结果3组术后48 h失血量、术后凝血酶原时间及术后活化部分凝血活酶时间(activated partial thromboplastin time,APTT)比较,差异无统计学意义(P>0.05),C组术后24 h失血量显著高于A组及B组,术后血红蛋白及红细胞比容均低于A组和B组,差异有统计学意义(P<0.05)。术后切口并发症:A组无感染及不愈合病例(0%),B组2例(6.67%),C组6例(20.00%),3组患者术后切口并发症发生率比较,差异有统计学意义(Z=7.683,P<0.05)。所有患者均未发生下肢深静脉血栓。结论跟骨骨折术后应用氨甲环酸,可以有效减少跟骨术后失血量。

Objective To observe the effect of different ways of application of tranexamic acid(TXA)on postoperative drainage of calcaneal fractures.Methods From July 2017 to July 2019,90 cases of SandersⅢ~Ⅳclosed calcaneal fractures were selected in the Affiliated Dalian the 3rd People's Hospital of Dalian Medical University.They were divide into 3 groups based on different processing methods,with 30 cases in each group:group A(15 mg/kg of tranexamic acid at 10 min before operation plus 100 ml of tranexamic acid for local and external use during operation),group B(0.9%NaCl at 10 min before operation and 100 ml of tranexamic acid during operation)and group C(0.9%NaCl at 10 min before operation).Intraoperative blood loss,postoperative blood loss 24 h and 48 h,postoperative prothrombin time,postoperative activated partial thrombin time,postoperative hemoglobin and hematopoietic volume were compared among the three groups.Results There were no significant differences in blood loss,prothrombin time and activated partial thromboplastin time(APTT)at 48 hours after surgery among the three groups at 48 hours after surgery(P>0.05).The 24 hours postoperative blood loss in group C was significantly higher than that in group A and group B,and the postoperative hemoglobin and hematocrit were lower than those in groups A and B(P<0.05).There were no infection and nonunion in group A(0%),there were 2 cases in group B(6.67%),there were 6 cases in group C(20.00%),there was significant difference in the incidence of postoperative incision complications among the three groups(Z=7.683,P<0.05).All patients had no lower extremity deep venous thrombosis.Conclusion The application of tranexamic acid can effectively reduce the postoperative blood loss of calcaneus.