| 氨甲环酸不同用药途径对女性股骨颈骨折全髋关节置换术失血的疗效的初步分析 |
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投稿时间：2018-06-16 修订日期：2018-08-15
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| 期刊信息：《中国骨伤》年，第卷，第期，第-页 |
| DOI： |
| 基金项目:温州市公益性科技计划项目（Y20160382） |
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| 中文摘要:目的：研究氨甲环酸不同应用方式治疗老年女性股骨颈骨折行全髋关节置换术围手术期失血的疗效。方法：将2015年12月至2018年1月老年女性股骨颈骨折行全髋关节置换术患者77例进行随机分组，A组（静脉用药组）21例，平均年龄（77.1±7.02）岁，于手术切皮前5 min 使用15 mg/kg TXA静脉滴注并且术中生理盐水灌注关节腔；B组（局部用药组）18例，平均年龄（73.83±6.56）岁，于手术切皮前5 min生理盐水静脉滴注并且术中使用总剂量为3 g 的TXA灌注关节腔；C组（联合用药组）19例，平均年龄（74.26±6.04）岁，术前使用15 mg/kg TXA静滴并且术中使用总剂量为1.5g 的TXA灌注关节腔；D组（对照研究组）19例，平均年龄（76.69±9.27）岁，于手术切皮前5 min生理盐水静脉滴注并且术中生理盐水灌注关节腔。对术后伤口引流量、血红蛋白值变化、根据身高体重和手术前后的红细胞压积(Hct)计算所有患者的总失血量等进行观察，并作统计学分析进行比较。结果：A组（静脉用药组）术后引流量为（111.91±35.02）ml，血红蛋白改变量为（26.86±12.99）g/L，总失血量为（628.6±306.78）ml；B组（局部用药组）术后引流量为（108.89±36.61）ml，血红蛋白改变量为（26.28±8.59）g/L，总失血量为（584.41±250.86）ml；C组（联合用药组）术后引流量为（102.63±47.36）ml，血红蛋白改变量为（26.89±12.47）g/L，总失血量为（634.78±384.89）ml；D组（对照研究组）术后引流量为（107.37±40.53）ml，血红蛋白改变量为（40.95±12.48）g/L，总失血量为（1005.24±483.37）ml；4组术后引流量无统计学差异（P>0．05）；A/B/C组术后血红蛋白该变量、总失血量少于对照组D组，差异有统计学意义（P＜0．05），但是三组组间比较无统计学差异（P>0．05）。结论：应用氨甲环酸能有效减少老年女性股骨颈骨折行全髋关节置换术围手术期失血，但是最佳给药方式及给药剂量需要进一步的研究。 |
| 【关键词】股骨颈骨折，关节置换，失血量、氨甲环酸 |
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| Effect of different routes of tranexamic acid on blood loss after total hip arthroplasty for female femur neck fracture |
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| ABSTRACT Objective：To study curative effect of different routes of tranexamic acid on blood loss of elderly female patients with femoral neck fracture in total hip arthroplasty .Methods：77 elderly women patients，who had total hip arthroplasty for treatment of femoral neck fractures from December 2015 to January 2018，were randomly divided into 4 groups．Group A (intravenous medication group) had 21 cases, with an average age of (77.1 + 7.02) years，was given intravenous drip of 15 mg/kg TXA 5 min before operation, and intraoperative saline infusion of the joint cavity. Group B (local medication group) had 18 cases, with an average age of (73.83 + 6.56) years，was intravenously injected with saline 5 min before operation, and TXA was injected into the joint cavity with a total dose of 3g during operation. Group C (combined medication group) had 19 cases, with an average age of (74.26 + 6.04)，was treated with intravenous infusion of 15 mg/kg TXA before operation and TXA was perfused with TXA at a total dose of 1.5g. Group D (control group), 19 cases, with an average age of (76.69 + 9.27) years，was intravenously injected with saline 5 min before operation and saline was injected into the joint cavity. The total drainage, the total blood loss and the amount of hemoglobin change were compared．Results：In group A (intravenous group), the postoperative drainage was（111.91±35.02）ml，The change of hemoglobin was (26.86 + 12.99) g/L, and the total blood loss was (628.6 + 306.78) ml. In group B (local medication group) ，the postoperative drainage was（108.89±36.61）ml，The change of hemoglobin was（26.28±8.59) g/L, and the total blood loss was (584.41±250.86)ml. In Group C (combined medication group), the postoperative drainage was （102.63±47.36）ml，The change of hemoglobin was (26.89±12.47) g/L, and the total blood loss was (634.78±384.89) ml. In Group D (control group), the postoperative drainage was （107.37±40.53）ml，The change of hemoglobin was (40.95±12.48) g/L, and the total blood loss was (1005.24±483.37) ml.There was no significant difference between the 4 groups in postoperative drainage volume (P>0.05). The hemoglobin and total blood loss in group A/B/C were less than those in control group D (P < 0.05)，However，there was no statistical difference between the three groups (P>0.05).Conclusion：Application of tranexamic acid can effectively reduce blood loss during perioperative period of total hip arthroplasty for elderly women with femoral neck fracture. The best route of administration and dosage should be further studied． |
| KEY WORDS Femoral neck fracture,Total hip replacement, Postoperative hemorrhage,TXA |
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