老年股骨转子间骨折PFNA内固定术前应用小剂量氨甲环酸效果分析

Effect of Applying Small⁃dosage Tranexamic Acid before the PFNA Internal Fixation for Femoral Intertrochanteric Fracture in the Elderly

目的分析老年股骨转子间骨折(FIF)股骨近端防旋髓内钉(PFNA)内固定术前应用小剂量氨甲环酸的临床疗效。方法选取2018年8月至2021年8月周口市人民医院收治的拟行PFNA内固定治疗的123例老年FIF患者作为研究对象,根据术前是否静脉滴注小剂量氨甲环酸将其分为滴注组(63例)和未滴注组(60例),滴注组患者PFNA内固定术前静脉滴注小剂量氨甲环酸注射液,未滴注组患者PFNA内固定术前不予以特殊处理,对比观察两组患者手术时间、失血量以及血红蛋白(Hb)、红细胞压积(Hct)、炎症因子水平与输血情况。结果滴注组患者手术时间与未滴注组无明显差异(t=0.244,P=0.808);滴注组患者总失血量、显性失血量与隐性失血量均明显少于未滴注组(t=18.132、2.176、19.171,P<0.001、P=0.032、P<0.001);术后3d,滴注组患者Hb、Hct水平均明显高于未滴注组(t=2.543、6.405,P=0.012、P<0.001),血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8、IL-10水平均明显低于未滴注组(t=27.577、33.817、43.193-21.052,P均<0.001);滴注组患者输血率为4.76%,明显低于未滴注组患者的输血率26.67%(χ^(2)=11.290,P<0.001)。结论PFNA内固定术前应用小剂量氨甲环酸能有效减少老年FIF患者围手术期失血量,减轻术后机体炎症反应,降低输血率。

Objective To analyze the clinical efficacy of applying small⁃dosage of tranexamic acid before the proximal femoral nail antirotation(PFNA)internal fixation for femoral intertrochanteric fracture(FIF)in the elderly.Methods 123 elderly patients with FIF admitted into Zhoukou People’s Hospital for PFNA internal fixation between August 2018 and August 2021 were enrolled as research subjects,and divided into drip group(n=63)and non⁃drip group(n=60)based on whether they received the intravenous drip of small⁃dosage tranexamic acid before surgery.Patients in the drip group received the intravenous drip of small⁃dosage Tranexamic Acid Injection before the PFNA internal fixation,while patients didn’t receive any management before the PFNA internal fixation in the non⁃drip group.The operation time,blood loss volume,the level of hemoglobin(Hb),hematocrit(Hct)and inflammatory factors,and transfusion condition of patients were compared between the two groups.Results No significant difference was observed between the drip group and non⁃drip group in terms of operation time(t=0.244,P=0.808),but the total blood loss volume,dominant blood loss volume and hidden blood loss volume of patients in the drip group were all obviously less than that in the non⁃drip group(t=18.132,2.176 and 19.171,P<0.001,P=0.032,P<0.001).On day 3 after surgery,the levels of Hb and Hct of patients were obviously higher in the drip group compared with the non⁃drip group(t=2.543 and 6.405,P=0.012,P<0.001),and the levels of serum tumor necrosis factor⁃α(TNF⁃α),interleukin(IL)⁃6,IL⁃8 and IL⁃10 of patients were all significantly lower in the drip group(t=27.577,33.817,43.193 and 21.052,all P<0.001).The rate of transfusion was 4.76%in the drip group,being markedly lower than the corresponding 26.67%in the non⁃drip group(χ^(2)=11.290,P<0.001).Conclusion The application of small⁃dosage tranexamic acid before the PFNA internal fixation can effectively decrease the blood loss of elderly patients with FIF during the perioperative period,alleviate their inflammatory responses after surgery,and reduce the rate of transfusion.