摘要
目的观察老年髋部骨折患者手术治疗过程中合理使用氨甲环酸对围手术期失血量的影响。方法130例老年髋部骨折患者,按照是否使用氨甲环酸分为观察组及对照组,每组65例。观察组在切皮前15 min滴注氨甲环酸,对照组滴注相同剂量的生理盐水作为对照。对比两组手术期间失血量(术中出血量、术后引流量、显性失血量、隐性失血量、总失血量),手术时间、手术前后血红蛋白水平,手术前后纤维蛋白原水平、凝血酶原时间、活化部分凝血活酶时间,术后恢复中并发症发生情况,术后负重时间、术后4个月Harris髋关节功能评分,恢复期间生活质量。结果观察组术中出血量、术后引流量、显性失血量、隐性失血量、总失血量分别为(86.55±2.45)、(25.04±3.54)、(74.65±4.52)、(66.21±13.42)、(252.45±25.12)ml,均明显少于对照组的(101.52±1.58)、(32.58±3.05)、(125.83±5.04)、(129.62±10.11)、(389.55±15.45)ml,差异具有统计学意义(P<0.05)。观察组手术时间为(64.55±4.55)min,与对照组的(65.04±3.71)min对比,差异无统计学意义(P>0.05)。术后24、48、72 h,观察组血红蛋白水平分别为(92.53±2.04)、(96.45±3.11)、(105.63±2.64)g/L,均高于对照组的(86.45±2.55)、(90.05±2.12)、(96.42±3.04)g/L,差异具有统计学意义(P<0.05)。两组患者手术前后的纤维蛋白原水平、凝血酶原时间、活化部分凝血活酶时间对比,差异无统计学意义(P>0.05)。观察组伤口感染发生率1.54%低于对照组的10.77%,差异具有统计学意义(P<0.05)。观察组术后负重时间为(11.35±2.12)周,短于对照组的(13.03±2.38)周,差异具有统计学意义(P<0.05)。观察组术后1、2、3、4个月的Harris髋关节功能评分分别为(71.55±3.42)、(85.63±2.12)、(90.12±3.05)、(94.63±2.12)分,均高于对照组的(65.52±2.42)、(75.42±2.74)、(81.42±2.52)、(86.42±3.54)分,差异具有统计学意义(P<0.05)。观察组恢复期间社会能力、心理功能、身体状态、精神评分分别为(93.54±2.74)、(94.58±1.95)、(92.47±2.06)、(93.14±2.12)分,均明显高于对照组的(82.54±2.42)、(83.54±2.11)、(85.68±2.42)、(84.14±2.32)分,差异具有统计学意义(P<0.05)。结论老年髋部骨折患者在手术治疗期间合理使用氨甲环酸进行治疗,可以有效减少患者围手术期失血量,降低输血率,且不会对患者凝血功能造成影响,有助于患者恢复,缩短患者住院时间。
Objective To observe the effect of rational use of tranexamic acid on perioperative blood loss in elderly patients with hip fractures.Methods A total of 130 elderly patients with hip fractures were divided into observation group and control group according to whether tranexamic acid was used or not,with 65 cases in each group.The observation group was infused with tranexamic acid 15 min before skin cutting,and the control group was infused with the same dose of normal saline.Both groups were compared in terms of blood loss(intraoperative blood loss,postoperative drainage,overt blood loss,occult blood loss,total blood loss)during surgery;operative time,hemoglobin level preoperatively and postoperatively;fibrinogen level,prothrombin time,activated partial thromboplastin time preoperatively and postoperatively;the occurrence of complications during postoperative recovery;postoperative weight-bearing time,Harris hip function score at 4 months after surgery;quality of life during recovery.Results The intraoperative blood loss,postoperative drainage,overt blood loss,occult blood loss,and total blood loss in the observation group were(86.55±2.45),(25.04±3.54),(74.65±4.52),(66.21±13.42),and(252.45±25.12)ml,which were significantly less than those of(101.52±1.58),(32.58±3.05),(125.83±5.04),(129.62±10.11),and(389.55±15.45)ml in the control group,and the differences were statistically significant(P<0.05).The operative time was(64.55±4.55)min in the observation group,and(65.04±3.71)min in the control group,and the difference was not statistically significant(P>0.05).At 24,48,and 72 h postoperatively,the hemoglobin levels in the observation group were(92.53±2.04),(96.45±3.11),and(105.63±2.64)g/L,which were higher than those of(86.45±2.55),(90.05±2.12),and(96.42±3.04)g/L in the control group,and the differences were statistically significant(P<0.05).The differences in fibrinogen level,prothrombin time,and activated partial thromboplastin time preoperatively and postoperatively were not statistically significant between the two groups(P>0.05).The incidence of wound infection in the observation group was 1.54%,which was lower than that of 10.77%in the control group,and the difference was statistically significant(P<0.05).The postoperative weight-bearing time in the observation group was(11.35±2.12)weeks,which was shorter than that of(13.03±2.38)weeks in the control group,and the difference was statistically significant(P<0.05).The Harris hip function scores at 1,2,3,and 4 months postoperatively in the observation group were(71.55±3.42),(85.63±2.12),(90.12±3.05),and(94.63±2.12),points,which were higher than those of(65.52±2.42),(75.42±2.74),(81.42±2.52),and(86.42±3.54)points in the control group,and the differences were statistically significant(P<0.05).The social ability,mental function,physical status,and mental scores in the observation group during recovery were(93.54±2.74),(94.58±1.95),(92.47±2.06),and(93.14±2.12)points,which were significantly higher than those of(82.54±2.42),(83.54±2.11),(85.68±2.42),and(84.14±2.32)points in the control group,and the differences were statistically significant(P<0.05).Conclusion The rational use of tranexamic acid during surgical treatment of hip fracture in the elderly can effectively reduce perioperative blood loss and blood transfusion rate,and will not affect the coagulation function of patients,which helps patients to recover and shorten their hospital stay.
作者
安春宇
AN Chun-yu(Laizhou People's Hospital,Laizhou 261400,China)
出处
《中国实用医药》
2023年第7期17-22,共6页
China Practical Medicine
关键词
氨甲环酸
老年髋部骨折
围手术期
失血量
Tranexamic acid
Hip fractures in the elderly
Perioperative period
Blood loss
