【摘要】 目的探讨术前序贯氨甲环酸减少老年股骨粗隆间骨折围手术期隐性失血的有效性和安全性。方法选取2017年2月至2018年2月纳入的56例老年股骨粗隆间骨折采用股骨近端防旋型髓内钉(PFNA)内固定手术患者随机分为对照组(n=28)和氨甲环酸组(n=28),对照组不予使用氨甲环酸,氨甲环酸组则从入院后至术前连续每天静脉使用氨甲环酸(10 mg/kg)1次,记录患者的手术时间、显性失血量、输血量及血栓发生事件,并通过Gross方程计算隐性失血量。结果两组患者在手术时间、显性失血量方面比较,组间差异均无统计学意义(>0.05),术前、术后及总隐性失血量、输血量均有统计学意义(<0.05),两组患者均未出现下肢深静脉血栓或肺栓塞。结论入院后至术前序贯氨甲环酸可明显减少老年股骨粗隆间骨折术前的隐性失血量及围手术期的输血量,而对术后的隐性失血量减少不明显,不增加血栓性疾病发生的风险。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of preoperative continuous intravenous use of tranexamic acid(TXA) for femoral intertrochanteric fractures in the elderly to reduce hidden blood loss. Methods A total of 56 elderly patients(from February 2017 to February 2018) with femoral intertrochanteric fractures treated by PFNA were randomly divided into two groups as follows: The control group had no any hemostatic interference given, the TXA group was given intravenous TXA preoperatively. The operative time, visible blood loss, blood transfusion and vascular occlusive events were tested. The hidden blood loss was calculated by the Gross equation. Results The operative time and visible blood loss were compared without a statistical difference between two groups( >0.05). Conversely, preoperative hidden blood loss, postoperative hidden blood loss, total hidden blood loss and blood transfusion were compared with a statistical difference between two groups( <0.05). Deep vein thrombosis and pulmonary embolism were not observed in any group.Conclusion Preoperative continuous intravenous application of TXA can significantly reduce preoperative hidden blood loss and peri-operative blood transfusion in the elderly patients with intertrochanteric fractures, but it is not obvious for the reduction of postoperative recessive blood loss, without increasing the risk of vascular occlusive events.更多还原