【摘要】 目的 探讨氨甲环酸局部注射加灌注对老年股骨粗隆间骨折行股骨近端防旋髓内钉(PFNA)内固定术患者术后出血量的影响。方法 80例行PFNA内固定术的股骨粗隆间骨折老年患者,随机分为对照组与观察组,各40例。观察组使用氨甲环酸局部注射加灌注,对照组未使用氨甲环酸。比较两组术中出血量、术后引流量、术后隐性出血量、术后失血总量、术后输血率、术后并发症发生情况及手术前后凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]。结果 对照组患者术中出血量为(147.48±10.58)ml,术后引流量为(158.48±25.46)ml,术后隐性出血量为(221.82±25.46)ml；观察组术中出血量为(98.74±12.47)ml,术后引流量为(60.47±17.34)ml,术后隐性出血量为(101.47±17.43)ml。观察组患者术中出血量、术后引流量、术后隐性出血量均少于对照组,差异有统计学意义(P<0.05)。对照组患者术后失血总量为(526.48±65.58)ml,观察组术后失血总量为(251.74±52.47)ml；对照组患者术后输血率为90.00%,观察组患者术后输血率为70.00%。观察组患者术后失血总量少于对照组,术后输血率低于对照组,差异有统计学意义(P<0.05)。观察组患者并发症发生率5.00%与对照组的5.00%比较,差异无统计学意义(P>0.05)。手术前及术后第1天,观察组患者PT和APTT与对照组组间比较,差异均无统计学意义(P>0.05)；术后第1天,两组患者PT和APTT均长于手术前,差异有统计学意义(P<0.05)。结论 对老年股骨粗隆间骨折患者行PFNA内固定术中给予氨甲环酸局部注射加灌注,能够明显降低其出血量,提高安全性,值得在临床上大力推广应用。更多还原

【Abstract】 Objective To discuss the effect of tranexamic acid local injection and perfusion on postoperative bleeding in elderly patients undergoing proximal femoral nail anti-rotation(PFNA) internal fixation for intertrochanteric fracture of the femur. Methods A total of 80 elderly patients with intertrochanteric fractures of the femur who underwent PFNA internal fixation were randomly divided into control group and observation group, with 40 cases in each group. The observation group received tranexamic acid local injection and infusion,while the control group did not use tranexamic acid. Both groups were compared in terms of intraoperative blood loss, postoperative drainage volume, postoperative occult blood loss, total postoperative blood loss, postoperative transfusion rate, postoperative complications and coagulation indexes [prothrombin time(PT), activated partial thromboplastin time(APTT)] before and after surgery. Results In the control group, the intraoperative blood loss was(147.48±10.58) ml, the postoperative drainage volume was(158.48±25.46) ml, and the postoperative occult blood loss was(221.82±25.46) ml; in the observation group, the intraoperative blood loss was(98.74±12.47) ml,the postoperative drainage volume was(60.47±17.34) ml, and the postoperative occult blood loss was(101.47±17.43) ml. The intraoperative blood loss, postoperative drainage volume and postoperative occult blood loss in the observation group were lower than those in the control group, and the differences were statistically significant(P<0.05). The total postoperative blood loss was(526.48±65.58) ml in the control group and(251.74±52.47) ml in the observation group; the postoperative blood transfusion rate was 90.00% in the control group and 70.00% in the observation group. The total postoperative blood loss in the observation group was lower than that in the control group, and the postoperative blood transfusion rate was lower than that in the control group.The differences were statistically significant(P<0.05). There was no statistically significant difference in the incidence of complications between the observation group(5.00%) and the control group(5.00%)(P>0.05). Before surgery and the first day after surgery, there was no statistically significant difference in PT and APTT between the observation group and the control group(P>0.05). On the first day after surgery, PT and APTT in both groups were longer than those before surgery in this group, and the differences were statistically significant(P<0.05).Conclusion Tranexamic acid local injection and perfusion in elderly patients undergoing PFNA internal fixation for intertrochanteric fracture of the femur can significantly reduce the amount of blood loss and improve the safety,which is worth promoting in clinical practice.更多还原