摘要
目的探讨氨甲环酸局部应用并不放置引流对高龄人工股骨头置换术患者失血量的影响。方法回顾性收集济宁医学院附属医院骨关节科收治的50例因股骨颈骨折行人工股骨头置换术的高龄患者,随机分为试验组和对照组,每组各25例。试验组在缝合阔筋膜张肌后关节腔注射2 g氨甲环酸,并加入生理盐水稀释至50 ml;对照组则关节腔注射50 ml生理盐水,2组术后均不放置引流。比较两组患者术中显性失血量、术后隐性失血量、总失血量、输血率、术后第1、3、5天血红蛋白以及下肢深静脉血栓、肺栓塞、切口感染等并发症的发生率。结果试验组第1、3、5天血红蛋白浓度高于对照组(t=7.473,t=7.226,t=7.572,P<0.05),其总失血量、显性失血量、隐性失血量及输血率低于对照组,差异有统计学意义(t=7.881,t=15.353,t=7.225,t=5.781,P<0.05)。两组患者术中出血量差异比较无统计学意义(t=1.382,P>0.05)。两组患者均无下肢深静脉血栓形成及肺栓塞发生。两组患者均有1例发生下肢肌间静脉血栓,无统计学差异。两组患者术后3 h相关凝血指标比较差异无统计学意义(t=1.483,t=1.352,t=1.466,P>0.05)。结论人工股骨头置换术中关节腔注射氨甲环酸并不放置引流,能有效减少术后失血和输血,不增加下肢深静脉血栓形成和肺栓塞的发生,对凝血无影响。
Objective To explore the effect of local application of tranexamic acid(TXA)without drainage on blood loss in elderly patients with hip hemiarthroplasty.Methods A retrospective study was performed in 50 elderly cases of femoral neck fractures who had underwent hip hemiarthroplasty in department of Bone and Joint Surgery of Affiliated Hospital of Jining Medical University.Patients were randomly divided into the TXA group(n=25)and the control group(n=25).The TXA group received the intra-articular injection of 2 g TXA dissolved in 50 ml of normal saline,the control group received the intra-articular injection of the same volume of normal saline before closing the incision.The drainage tube was not used in both groups.The intraoperative blood loss,external blood loss,hidden blood loss,total blood loss,transfusion rate,postoperative hemoglobin concentration and complications were compared between the two groups.Results The postoperative hemoglobin concentrations in the TXA group were higher than those in the control group(t=7.473,t=7.226,t=7.572,P<0.05).The total blood loss,external blood loss,hidden blood loss and blood transfusion rate were lower than those in the control group(t=7.881,t=15.353,t=7.225,t=5.781,P<0.05).There were no significant difference in the intraoperative blood loss and postoperative 3-hour-related blood coagulation indexes between the two groups(t=1.382,P<0.05).No deep vein thrombosis and pulmonary embolism occurred in the two groups.Each group had 1 case of intermuscular venous thrombosis,there was no significant difference between the two groups.There was no significant difference in the coagulation parameters between the two groups at 3 h after surgery (t=1.483, t=1.352, t=1.466, P>0.05). ConclusionLocal application of tranexamic acid (TXA) without drainage can effectively reduce perioperative blood lossand transfusion rate, and does not increase the incidence of complications in the elderly patients with hiphemiarthroplasty.
作者
段国庆
宋世强
张元民
Duan Guoqing;Song Shiqiang;Zhang Yuanmin(Department of Bone and Joint Surgery Affiliated Hospital of Jining Medical University,Jining 272029,China)
出处
《中华老年骨科与康复电子杂志》
2019年第4期201-205,共5页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
济宁医学院青年教师科研扶持基金（JY2017FS012）
关键词
股骨颈骨折
关节成形术
置换
髋
氨甲环酸
失血
手术
静脉血栓形成
Femoral neck fractures
Arthroplasty, replacement, hip
Tranexamic acid
Bloodloss, sugical
Venous thrombosis
