文章摘要
王志猛,路遥,王谦,马腾,李忠,张堃,雷利国.复杂胫骨平台骨折术后多次静脉应用氨甲环酸的有效性及安全性.骨科,2019,10(5):428-433
复杂胫骨平台骨折术后多次静脉应用氨甲环酸的有效性及安全性
Efficacy and safety of multiple intravenous tranexamic acid in complex tibial plateau fractures
投稿时间:2019-05-10  
DOI:10.3969/j.issn.1674-8573.2019.05.012
中文关键词: 氨甲环酸  复杂骨折  抗纤溶  失血量
英文关键词: Tranexamic acid  Complex fractures  Anti-fibrinolysis  Blood loss
基金项目:陕西省自然科学基金(2017ZDXM-SF-009)
作者单位E-mail
王志猛 西安医学院西安 710068西安交通大学医学院附属红会医院骨科西安 710054  
路遥 西安交通大学医学院附属红会医院骨科西安 710054  
王谦 西安交通大学医学院附属红会医院骨科西安 710054  
马腾 西安交通大学医学院附属红会医院骨科西安 710054  
李忠 西安交通大学医学院附属红会医院骨科西安 710054  
张堃 西安交通大学医学院附属红会医院骨科西安 710054  
雷利国 彬州市中医医院外二科陕西彬州 713500 1968580419@qq.com 
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中文摘要:
      目的 探讨复杂胫骨平台骨折(Schatzker Ⅴ、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Schatzker Ⅴ、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。
英文摘要:
      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 March 2018 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 at 3rd and 6th 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.
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