| 张大华,张 祥,刘 军,刘晓春,郭书章.氨甲环酸在老年股骨转子间骨折伤后早期的应用研究[J].,2022,(7):1328-1332 |
| 氨甲环酸在老年股骨转子间骨折伤后早期的应用研究 |
| Study on the Early Application of Tranexamic Acid after Intertrochanteric Fracture in the Elderly |
| 投稿时间：2021-09-07 修订日期：2021-09-30 |
| DOI：10.13241/j.cnki.pmb.2022.07.028 |
| 中文关键词: 老年股骨转子间骨折 伤后早期 氨甲环酸 术前隐性失血 深静脉血栓 |
| 英文关键词: Femoral intertrochanteric fracture in the elderly Early post injury Tranexamic acid Preoperative occult blood loss Deep venous thrombosis |
| 基金项目:陕西省自然科学基础研究计划项目（2019JM-524） |
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| 中文摘要: |
| 摘要 目的：研究老年股骨转子间骨折伤后早期使用氨甲环酸（tranexamic acid，TXA）的有效性和安全性。方法：2021年4月到2021年8月选择在本院诊治的符合纳入标准的老年股骨转子间骨折患者70例作为研究对象，根据随机数字表法把患者分为TXA组与对照组各35例。TXA组于伤后6小时内静脉滴注TXA1g（与100 mL生理盐水配伍，半小时滴完），对照组伤后6小时内静脉滴注生理盐水100 mL。观察指标：入院即刻及伤后第1、2天和术前清晨红细胞压积（Hct）、红细胞（RBC）、血红蛋白（Hb）、纤维蛋白原（FIB）、D-二聚体（D-Dimer）。术前2小时、术后2周查下肢静脉血管B超明确有无下肢深静脉血栓形成。观察记录术后伤口感染、伤后出血并发症发生情况。疗效指标包括术前隐性失血量、术前输血率。安全性指标为围手术期深静脉血栓发生率、术后伤口并发症发生率。结果：（1）两组患者伤后第1、2天和术前清晨红细胞压积、红细胞、血红蛋白水平和D-二聚体随时间延长逐渐降低，纤维蛋白原逐渐增加（P＜0.05）。伤后第1、2天和术前清晨TXA组红细胞压积、红细胞、血红蛋白水平均高于对照组（P＜0.001）。（2）伤后第1、2天和术前清晨两组隐性失血量随时间延长逐渐增加，TXA组隐性失血量均低于对照组（P＜0.001）。（3）TXA组术前输血率显著低于对照组（P＜0.001）。结论：TXA伤后早期应用可有效降低老年股骨转子间骨折患者术前的隐性失血量，降低术前输血率，不增加围手术期深静脉血栓发生率，且减少术后伤口并发症。 |
| 英文摘要: |
| ABSTRACT Objective: To study the efficacy and safety of early use of tranexamic acid (TXA) after femoral intertrochanteric fracture in the elderly. Methods: From April 2021 to August 2021, 70 elderly patients with femoral intertrochanteric fracture who met the inclusion criteria were selected as the research objects. According to the random number table, the patients were divided into TXA group and control group, with 35 cases in each group. TXA group was intravenously injected with txa1g (compatible with 100 mL normal saline, half an hour) within 6 hours after injury, and the control group was intravenously injected with 100 mL normal saline within 6 hours after injury. Outcome measures: hematocrit (HCT), red blood cell (RBC), hemoglobin (HB), fibrinogen (FIB) and D-Dimer (D-dimer) immediately after admission, on the first and second days after injury and in the morning before operation. The venous vessels of lower limbs were examined by B-ultrasound 2 hours before operation and 2 weeks after operation to determine whether there was deep venous thrombosis of lower limbs. The complications of postoperative wound infection and bleeding were observed and recorded. The efficacy indexes included preoperative occult blood loss and preoperative blood transfusion rate. The safety indexes were the incidence of perioperative deep venous thrombosis and the incidence of postoperative wound complications. Results: (1) The hematocrit, red blood cell, hemoglobin level and D-dimer of the two groups of patients decreased gradually over time on the 1st and 2nd day after injury and early morning before operation, and fibrinogen gradually increased (P<0.05). The hematocrit, red blood cell and hemoglobin levels of TXA group were higher than those of the control group on the 1st and 2nd day after injury and early morning before operation (P＜0.001). (2) The hidden blood loss of the two groups gradually increased with time on the first and second days after injury and the early morning before operation. The hidden blood loss of the TXA group was lower than that of the control group (P<0.001). (3) The preoperative blood transfusion rate in the TXA group was significantly lower than that in the control group (P<0.001). Conclusion: Early application of TXA after injury can effectively reduce the preoperative occult blood loss of elderly patients with femoral intertrochanteric fracture, reduce the preoperative blood transfusion rate, do not increase the incidence of perioperative deep venous thrombosis, and reduce postoperative wound complications. |
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