摘要
目的探讨复杂胫骨平台骨折(SchatzkerⅤ、Ⅵ)术后多次静脉应用氨甲环酸(Tranexamic acid, TXA)抑制纤溶及减少失血的安全性及有效性。方法将2018年3月至2019年1月西安交通大学医学院附属红会医院骨科收治拟行手术,且符合本研究纳入与排除标准的70例复杂胫骨平台骨折病人,按照就诊顺序分为两组,每组各35例。对照组:松止血带前5~10 min静脉点滴TXA(15 mg/kg);观察组:松止血带前5~10 min静脉点滴TXA(15 mg/kg),术后3 h、6 h后各再次静脉追加1 g TXA。记录并比较两组病人的总失血量、隐性失血量、输血率、48 h引流量、纤溶水平、静脉血栓性疾病、术后伤口并发症等情况。结果两组病人均无输血者。对照组总失血量为(792.86±202.86)ml,观察组为(692.29±124.90)ml;对照组隐性失血量为(318.01±83.41)ml,观察组为(266.29±60.98)ml;对照组术后48 h引流量为(277.14±129.24)ml,观察组为(207.14±124.35)ml;对照组术后24 h D-二聚体值为(5.16±4.23)mg/L,观察组为(3.98±1.42)mg/L;对照组术后24 h纤维蛋白降解产物为(4.38±3.41)mg/L,观察组为(3.98±1.11)mg/L;对照组术后伤口红肿渗出率1例(3.70%),观察组未发生术后伤口红肿渗出;以上指标两组间比较,差异均有统计学意义(P均<0.05)。两组间术后下肢静脉血栓、肺栓塞及其他伤口并发症发生率比较,差异均无统计学意义(P均>0.05)。结论对于SchatzkerⅤ、Ⅵ复杂胫骨平台骨折,术后3 h、6 h静脉追加1 g TXA,可以进一步抑制术后机体纤溶亢进,降低术后的总失血量、隐性失血量、48 h引流量,减少术后血红蛋白丢失,且不增加血栓性疾病发生风险。同时,TXA有一定的抗炎作用,能减少术后伤口红肿渗出的发生。
Objective To assess the efficacy and safety of multiple intravenous tranexamic acid(TXA for anti-fibrinolysis and blood loss in complex tibial plateau fractures(Schatzker Ⅴ and Ⅵ). Methods A prospective study was conducted on 70 patients with underwent complex tibial plateau fractures from March2018 to January 2019 in Honghui Hospital. A dose of 15 mg/kg TXA was intravenously given in the control group and experimental group 10 to 15 min before loosing tourniquet, subsequently 2 doses of 1 g TXA added at3 rd and 6 th h after the first administration in experimental group. Total blood loss, occult blood loss,hemoglobin, transfusion rate, fibrinolysis parameters, 48 h drainage flow, venous thromboembolism and complications were compared between the two groups. Results No transfusion was given in two groups. The total blood loss in the experimental group(692.29±124.90 ml) was significantly less than that in the control group(792.86±202.86 ml, P<0.05). The occult blood loss in the experimental group(266.29±60.98 ml) was also less than in the control group(318.01±83.41 ml, P<0.05). The 48-h drainage flow in the experimental group(207.14±124.35 ml) was also less than in the control group(277.14±129.24 ml, P<0.05). The fibrin degradation products(FDP)[(3.98±1.11) mg/L vs.(4.38±3.41) mg/L, P<0.05]and D-dimer[(3.98±1.42) mg/L vs.(5.16±4.23) mg/L, P<0.05]in the experimental group were significantly reduced as compared with those in the control group at 24 h postoperatively(P<0.05), but there was no statistically significant differences in FDP and D-dimer between two groups at 72 h postoperatively(P>0.05). Rate of wound redness and excretion in the experimental group was significantly lower than in the control group[0 vs. 1(3.70%), P<0.05]. No significant difference was noted between two groups in another incidence of complications, such as venous thromboembolism, ecchymosis and swelling(P>0.05). Conclusion Multiple intravenous injection of TXA in complex tibial plateau fractures does effectively inhibit fibrinolysis system and reduce blood loss, and it had some anti-inflammatory effects without increasing the risk of venous thromboembolism.
作者
王志猛
路遥
王谦
马腾
李忠
张堃
雷利国
WANG Zhi-meng;LU Yao;WANG Qian;MA Teng;LI Zhong;ZHANG Kun;LEI Li-guo(Xi’an Medical University,Xi'an 710068,China;Department of Orthopaedics,Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University,Xi'an 710054,China;Department of Surgery,Binzhou Traditional Chinese Medicine Hospital,Binzhou 713500,China)
出处
《骨科》
CAS
2019年第5期428-433,共6页
ORTHOPAEDICS
基金
陕西省自然科学基金(2017ZDXM-SF-009)
关键词
氨甲环酸
复杂骨折
抗纤溶
失血量
Tranexamic acid
Complex fractures
Anti-fibrinolysis
Blood loss
