氨甲环酸不同给药方式对老年髋部骨折患者围术期失血量、纤溶指标及炎症因子的影响

Effects of different administration methods of tranexamic acid on perioperative blood loss,fibrinolytic index and inflammatory factors in elderly patients with hip fracture

目的:探究氨甲环酸不同给药方式对老年髋部骨折患者围术期失血量、纤溶指标及炎症因子的影响。方法:选择178例老年髋部骨折患者为研究对象。按氨甲环酸给药方式不同分为对照组和观察组,每组各89例。对照组采取关节腔内局部注射给药;观察组采取静脉注射联合关节腔内局部注射给药。比较两组围术期失血量、纤溶指标[纤维蛋白原降解产物(FDP)、D二聚体(D-D)]、炎症因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平。结果:观察组围术期总失血量、术中失血量、隐性失血量、显性失血量、术后引流量均少于对照组(P<0.05);异体输血率低于对照组(P<0.05);术后1、3 d,观察组FDP、D-D、CRP、IL-6水平均低于对照组(P<0.05);术后3个月,两组静脉血栓发生率比较,差异无统计学意义(P>0.05)。结论:在老年髋部骨折患者手术期间使用静脉注射联合关节腔内局部注射氨甲环酸的方式较局部注射单用可减少围术期失血,抑制纤溶及炎症反应,且不会增加静脉血栓形成风险。

Objective:To investigate the effects of different administration methods of tranexamic acid on perioperative blood loss,fibrinolysis and inflammatory factors in elderly patients with hip fracture.Methods:A total of 178 elderly patients with hip fracture were divided into control group and observation group according to different ways of administration of tranexamic acid,with 89 cases in each group.The control group was treated with intra-articular local injection,and the observation group was treated with intravenous injection combined with intra-articular local injection.The perioperative blood loss,fibrinolytic indexes[fibrinogen degradation product(FDP),D-dimer(D-D)],inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)]were compared between the two groups.Results:The total blood loss,intraoperative blood loss,hidden blood loss,dominant blood loss and postoperative drainage volume in the observation group were less than those in the control group(P<0.05).The allogeneic blood transfusion rate in the observation group was lower than that in the control group(P<0.05).The levels of FDP,D-D,CRP and IL-6 in the observation group were lower than those in the control group at 1 and 3 d after operation(P<0.05).3 months after operation,there was no significant difference in the incidence of venous thrombosis between the observation group and the control group(P>0.05).Conclusion:Intravenous injection combined with intra-articular local injection of tranexamic acid during operation in elderly patients with hip fracture can significantly reduce perioperative blood loss,inhibit fibrinolysis and inflammatory response,and will not increase the risk of venous thrombosis.