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[1]胡維信,郭永傳,賈思明.局部應(yīng)用氨甲環(huán)酸對老年股骨轉(zhuǎn)子間骨折患者術(shù)后失血量的影響[J].中醫(yī)正骨,2018,30(04):39-42.
　HU Weixin,GUO Yongchuan,JIA Siming.Effect of local application of tranexamic acid on postoperative blood loss in aged patients with femoral intertrochanteric fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(04):39-42.
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局部應(yīng)用氨甲環(huán)酸對老年股骨轉(zhuǎn)子間骨折患者術(shù)后失血量的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年04期
頁碼:
39-42
欄目:
臨床研究
出版日期:
2018-04-20

文章信息/Info

Title:
Effect of local application of tranexamic acid on postoperative blood loss in aged patients with femoral intertrochanteric fractures
作者:
胡維信; 郭永傳; 賈思明
河南省開封市中心醫(yī)院,河南 開封 475099
Author(s):
HU Weixin; GUO Yongchuan; JIA Siming
Kaifeng Central Hospital,Kaifeng 475099,Henan,China
關(guān)鍵詞:
髖骨折;  轉(zhuǎn)子間骨折;  老年人;  骨折固定術(shù); 髓內(nèi);  手術(shù)后出血;  氨甲環(huán)酸
Keywords:
Keywords hip fractures;  intertrochanteric fractures;  aged;  fracture fixation; intramedullary;  postoperative hemorrhage;  tranexamic acid
摘要:
目的:探討局部應(yīng)用氨甲環(huán)酸對老年股骨轉(zhuǎn)子間骨折患者術(shù)后失血量的影響及其安全性。方法:將符合入選標(biāo)準(zhǔn)的60例老年股骨轉(zhuǎn)子間骨折患者隨機(jī)分為氨甲環(huán)酸組(30例)與生理鹽水組(30例)。60例患者均行閉合復(fù)位股骨近端防旋髓內(nèi)釘內(nèi)固定治療,術(shù)中在關(guān)閉近端切口前,氨甲環(huán)酸組將1 g氨甲環(huán)酸溶入20 mL生理鹽水中,注射于大腿近端外側(cè)骨折部位周圍深筋膜下方; 生理鹽水組于相同部位注射等量的生理鹽水。術(shù)后第1、第3、第5天復(fù)查血常規(guī),以術(shù)后第5天的檢測結(jié)果計(jì)算失血量。總失血量=術(shù)前血容量×(術(shù)前紅細(xì)胞壓積-術(shù)后第5天紅細(xì)胞壓積); 術(shù)中失血量=術(shù)中吸引瓶液體量-沖洗液量+紗布增加的質(zhì)量; 術(shù)后失血量=總失血量-術(shù)中失血量+輸血量。記錄2組患者總失血量、術(shù)后失血量、輸血例數(shù)、輸血量及術(shù)后血紅蛋白含量下降值(術(shù)前血紅蛋白含量檢測值-術(shù)后第1天血紅蛋白含量檢測值),觀察下肢深靜脈血栓形成、肺栓塞等并發(fā)癥發(fā)生情況。結(jié)果:2組患者均順利完成手術(shù)。氨甲環(huán)酸組總失血量、術(shù)后失血量、輸血量、術(shù)后血紅蛋白含量下降值均低于生理鹽水組[(410.9±65.2)mL,(565.4±72.8)mL,t=8.659,P=0.000;(326.0±75.9)mL,(392.2±81.4)mL,t=3.258,P=0.002;(70.5±146.5)mL,(190.4±151.6)mL,Z=-4.073,P=0.000;(16.2±8.1)g·L-1,(25.1±5.4)g·L-1,t=5.007,P=0.000]; 氨甲環(huán)酸組輸血2例,生理鹽水組輸血8例,氨甲環(huán)酸組輸血患者的比例小于生理鹽水組(χ2=4.320,P=0.038)。2組患者均未發(fā)現(xiàn)下肢深靜脈血栓形成、肺栓塞、感染及皮膚壞死等并發(fā)癥。結(jié)論:閉合復(fù)位股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折,術(shù)中局部應(yīng)用氨甲環(huán)酸可有效減少患者術(shù)后失血量,且無增加下肢深靜脈血栓形成、肺栓塞等并發(fā)癥發(fā)生的風(fēng)險(xiǎn),安全性高。
Abstract:
ABSTRACT Objective:To explore the effect of local application of tranexamic acid on postoperative blood loss in aged patients with femoral intertrochanteric fractures and its safety.Methods:Sixty aged patients with femoral intertrochanteric fractures who met the inclusion criteria were randomly divided into tranexamic acid group and normal saline(NS)group,30 cases in each group.All patients were treated with closed reduction and proximal femoral nail anti-rotation(PFNA)internal fixation.The tranexamic acid(1 g),dissolved in normal saline(20 mL),were injected into the space underneath the deep fascia around the lateral fractured sites of proximal thighs before the incision was sutured in tranexamic acid group,and the same dose of NS were injected into the same region in NS group.The routine blood test was performed on the 1st,3rd and 5th day after surgery respectively,and the blood loss was calculated according to the examination results obtained on the 5th day after surgery.The total blood loss was calculated by multiplying the preoperative blood volume by the difference between preoperative hematokrit and postoperative day 5 hematokrit.The intraoperative blood loss was calculated by subtracting the volume of rinse solution from the volume of intraoperative liquid in suction bottle and plusing the increased mass of carbasus.The postoperative blood loss was calculated by subtracting the intraoperative blood loss from the total blood loss and plusing the blood transfusion volume.Total blood loss,postoperative blood loss,blood transfusion rate,blood transfusion volume and postoperative decreased values of hemoglobin(HGB)content(difference in HGB content between pre-surgery and postoperative day 1)were recorded and compared between the 2 groups,and the complications such as lower extremity deep venous thrombosis(DVT)and pulmonary embolism were observed.Results:The surgeries were finished successfully in all patients.Total blood loss,postoperative blood loss,blood transfusion volume and postoperative decreased values of HGB content were lower in tranexamic acid group compared to NS group(410.9+/-65.2 vs 565.4+/-72.8 mL,t=8.659,P=0.000; 326.0+/-75.9 vs 392.2+/-81.4 mL,t=3.258,P=0.002; 70.5+/-146.5 vs 190.4+/-151.6 mL,Z=-4.073,P=0.000; 16.2+/-8.1 vs 25.1+/-5.4 g/L,t=5.007,P=0.000).Blood transfusions were performed in tranexamic acid group(2)and NS group(8),and the blood transfusion rate was smaller in tranexamic acid group compared to NS group(χ2=4.320,P=0.038).No complications such as lower extremity DVT,pulmonary embolism,infection and cutaneous necrosis were found in the 2 groups.Conclusion:Local application of tranexamic acid can effectively reduce postoperative blood loss in aged patients who receive PFNA internal fixation for treatment of femoral intertrochanteric fractures,and it has high safety considering it does not increase the risk of complications such as lower extremity DVT and pulmonary embolism.

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更新日期/Last Update: 2018-08-24