三七粉口服联合氨甲环酸局部应用对老年股骨隆间骨折围手术期失血量的影响

Effect of Oral Administration of Panax Pseudo-Ginseng Combined with Topical Application of Tranexamic Acid on Perioperative Blood Loss of Senile Intertrochanteric Fracture

目的 探讨三七粉口服联合氨甲环酸局部应用对老年股骨粗隆间骨折围手术期失血量的影响。方法 选取2020年8月—2022年8月期间河南省濮阳市中医医院收治股骨近端防旋髓内钉(Proximal Femoral Nail Anti-rotation, PFNA)治疗的老年股骨粗隆间骨折患者80例,按随机数字表法分为治疗组和对照组,每组各40例。手术均由同一团队完成,治疗组患者术前口服三七粉,对照组患者术前不服用任何药物,且两组患者术中均对股骨髓腔和尾骨周围灌注氨甲环酸。测定两组患者手术前后血红蛋白(Hemoglobin, HB)、红细胞压积(Hematocrit, HCT)及D-二聚体水平,对两组患者术后进行Harris髋关节评分,统计两组患者总失血量、显性失血量、隐性失血量及血栓性并发症发生率。结果 术后7 d两组患者HB、HCT及D-二聚体水平均较术前降低,差异有统计学意义(P<0.05);且治疗组HB、HCT水平较对照组降幅更小,D-二聚体水平较对照组降幅更多,差异有统计学意义(P<0.05)。治疗组总失血量、显性失血量及隐性失血量均明显低于对照组,差异有统计学意义(P<0.05)。术后3个月两组患者Harris髋关节评分均较术后1个月上升,差异有统计学意义(P<0.05);且治疗组高于对照组,差异有统计学意义(P<0.05)。两组患者血栓性并发症发生情况比较,差异无统计学意义(P>0.05)。结论 三七粉联合氨甲环酸局部应用的止血效果显著,有效降低股骨隆间骨折围术期失血量,且能有效抗凝,降低血栓性并发症的发生率,促进患者髋关节功能恢复。

Objective To study the effect of oral administration of panax pseudo-ginseng combined with topical application of tranexamic acid on perioperative blood loss of senile intertrochanteric fracture.Methods From August 2020 to August 2022,80 elderly patients with intertrochanteric fractures who were treated with proximal femoral nail anti-rota-tion(PFNA)in Puyang Hospital of Traditional Chinese Medicine,Henan Province were randomly divided into the treatment group and control group according to the random number table method,with 40 cases in each group.All operations were performed by the same team.Patients in the treatment group took panax pseudo-ginseng orally before the operation,while those in the control group did not take any drugs before the operation,and tranexamic acid was injected into the joint cavity in both groups during the operation.The levels of hemoglobin(HB),hematocrit(HCT),and D-dimer were measured be-fore and after the operation,and Harris hip score was used to evaluate the total blood loss,dominant blood loss,recessive blood loss,and the incidence of thrombotic complications in patients after the operation.Results On the 7th day after the operation,HB,HCT,and D-dimer decreased in both groups,and the difference was statistically significant(P<0.05).In addition,HB and HCT in the treatment group decreased less than those in the control group,and D-dimer decreased more than that in the control group(P<0.05).The total blood loss,dominant blood loss,and recessive blood loss in the treat-ment group were significantly lower than those in the control group(P<0.05).Harris hip score increased in both groups three months after the operation,especially in the treatment group(P<0.05).There was no significant difference in the in-cidence of thrombotic complications between the two groups(P>0.05).Conclusion Panax pseudo-ginseng combined with topical application of tranexamic acid has a remarkable hemostatic effect,effectively reduces perioperative blood loss of intertrochanteric fracture,and achieves effective anticoagulation.It can reduce the incidence of thrombotic complications and promote the functional recovery of the hip joint.