氨甲环酸对老年转子间骨折髓内钉固定术后隐性失血的影响
发布时间：2018-03-20 01:33
本文选题：氨甲环酸 切入点：转子间 出处：《河北医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:随着人类逐渐步入老龄化社会,老年转子间骨折发病率呈逐年上升的趋势。股骨近端防旋髓内钉(PFNA)是目前治疗转子间骨折的首选方法。但PFNA术后常常存在较大隐性失血。由隐性失血导致的贫血如不及时纠正,将影响伤口愈合,延长住院时间,增加患者术后肺水肿、脑水肿的发生率。为纠正隐性失血往往要进行输血,而输血存在传播疾病,导致输血相关性肺损伤,移植物抗宿主病等并发症的风险。氨甲环酸作为传统的抗纤溶药物,能与纤溶酶和纤溶酶原上的赖氨酸结合部位相结合,抑制了纤溶酶和纤溶酶原的活性,从而阻止了纤维蛋白的分解而发挥抗纤溶作用。文献报道氨甲环酸能够显著减少心脏、肝脏及妇产科手术的出血量。在骨科领域,氨甲环酸主要用于减少髋、膝关节置换和脊柱手术的出血量及降低输血率,但目前尚无研究关于氨甲环酸对老年转子间骨折术后隐性失血影响的报道。本实验旨在评估氨甲环酸对老年转子间骨折髓内钉固定术后隐性失血的影响。方法:自2016年1月~2017年1月期间,我院共治疗符合纳入标准的老年转子间骨折患者100例,按随机数字表法随机分为实验组和对照组,每组50例。实验组男性19例,女性31例;平均年龄77.74±6.53岁,身高1.63±0.08米,体重64.37±12.88千克。按AO/OTA分型:A1型24例,A2型19例,A3型7例。按ASA分级:Ⅰ级9例,Ⅱ级29例,Ⅲ级12例。全部采用PFNA进行固定,且氨甲环酸10 mg.kg-1术前10分钟及术后5小时各静点一次。对照组男性14例,女性36例;平均年龄79.25±6.55岁,身高1.60±0.08米,体重59.03±11.68千克。按AO/OTA分型:A1型29例,A2型15例,A3型6例。按ASA分级:Ⅰ级9例,Ⅱ级23例,Ⅲ级18例。治疗方法与实验组相同,但不应用氨甲环酸。所有患者术日8:00行血常规检查,记录术中失血、术后引流及术后输血量,术后第2天8:00复查血常规。按Gross方程分别计算两组患者的总失血量和隐性失血量。所有患者术前及术后1周行双下肢深静脉超声检查,记录血栓发生情况。所有均数用(?)±S表示,数据应用SPSS 21.0软件作统计处理,计数资料采用t检验,计量资料采用χ2检验,以P0.05为差异有统计学意义。结果:实验组术中失血量为(73.25±30.22)ml,术后引流量为(40.09±16.54)ml,显性失血量(术中失血量+术后引流量)为(113.34±75.82)ml,总失血量为(515.30±278.79)ml,隐性失血量为(401.96±260.72)ml。共有24人进行输血,平均输血量为(160±71.73)ml,输血率为48.0%。对照组术中失血量为(107.43±33.29)ml,术后引流量为(56.86±20.20)ml,显性失血量为(164.29±88.052)ml,总失血量为(696.88±275.00)ml,隐性失血量为(532.60±253.41)ml。共有34人进行输血,平均输血量为(270±109.41)ml,输血率为68.0%。经统计学分析,实验组的显性失血量、总失血量、隐性失血量、输血量及输血率均低于对照组,差异均有统计学意义(P0.05)。实验组中使用短钉固定的患者比长钉者隐性失血减少了123.04ml,差异有统计学意义(P=0.024);对照组中使用短钉固定的患者比长钉者隐性失血减少了142.53ml,差异有统计学意义(P=0.016)。两组患者术后一周下肢深静脉血栓的发生率无统计学差异(P=0.938)。结论:氨甲环酸能减少老年转子间骨折髓内钉固定术后的隐性失血量,且不增加发生双下肢深静脉血栓的风险。
[Abstract]:Objective: with the development of mankind has gradually entered the aging society, the elderly intertrochanteric fracture incidence increased year by year. The proximal femoral nail anti rotation (PFNA) is currently the preferred method of treatment of intertrochanteric fractures. But after PFNA often there is a big hidden blood loss. Hidden blood loss caused by anemia if not corrected the effect of wound healing, prolonged hospitalization, postoperative pulmonary edema increased, the incidence of hemorrhagic brain edema. To correct the recessive often requires blood transfusion, and blood transfusion existence spread disease, cause of transfusion related lung injury, the risk of complications such as graft-versus-host disease. Tranexamic acid as anti fibrinolytic drugs tradition. Can be combined with plasmin and plasminogen on lysine binding sites inhibits plasmin and plasminogen activity, thereby preventing the breakdown of fibrin and play the role of anti fibrinolytic. Tranexamic acid reported in literature. Can significantly reduce the amount of bleeding heart, liver and obstetrics and gynecology surgery. In the Department of orthopedics, tranexamic acid is mainly used to reduce the amount of bleeding of hip, knee joint replacement and spine surgery and decrease the rate of blood transfusion, but there is no research on the effect of tranexamic acid on hidden blood loss for the intertrochanteric fractures in the elderly patients after this experiment reports. To evaluate the effect of tranexamic acid on fixation of hidden blood loss after intramedullary nailing of senile intertrochanteric fracture. Methods: from January 2016 ~2017 January, in our hospital were treated with 100 cases of elderly patients with intertrochanteric fracture of the rotor into the standard, according to the random number table method were randomly divided into experimental group and control group, 50 cases in each group. The experimental group male 19 cases, female 31 cases; mean age 77.74 + 6.53, 1.63 + 0.08 meters height, weight 64.37 + 12.88 kg. According to AO/OTA classification: type A1 24 cases, A2 19 cases, type A3 7 cases. According to ASA classification: 9 cases of grade I, grade II in 29 cases, 12 patients with grade III. 鍏ㄩ儴閲囩敤PFNA杩涜鍥哄畾,涓旀皑鐢茬幆閰，
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