| 王志猛,路遥,王谦,等.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） |
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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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