早期氨甲环酸干预降低老年骨质疏松性股骨远端骨折伤后隐性失血的研究

Study on early tranexamic acid intervention to reduce hidden blood loss in elderly patients with osteoporotic distal femoral fracture

摘要:

目的： 探讨早期氨甲环酸（tranexamic acid，TXA）干预对老年骨质疏松性股骨远端骨折患者伤后隐性失血（hidden blood loss，HBL）的影响。方法： 采用回顾性分析方法，收集重庆市人民医院2018年10月至2020年10月收治的老年骨质疏松性股骨远端骨折患者（≥65岁）作为研究对象，根据患者入院时间先后分为TXA组（2018年10月至2019年10月）和NS组（2019年10月至2020年10月）。TXA组入院后即刻一次性给予TXA 2 g静脉滴注，NS组于入院后即刻给予等量NS静脉滴注。统计2组患者一般资料、伤后1～3 d血红蛋白（hemoglobin，HGB）、红细胞压积（hematocrit，HCT）及HBL变化、输血率、深静脉血栓/肺栓塞发生率等。结果： 共纳入87例患者，其中TXA组45例、NS组42例，2组患者一般资料比较均无统计学差异（P>0.05）；TXA组及NS组伤后1～3 d的HGB及HCT水平入院后随时间延长而降低（P<0.05），伤后2 d、3 d TXA组HGB水平均高于NS组（P<0.05），TXA组伤后1～3 d HCT水平均低于NS组（P<0.05）；伤后1～3 d TXA组及NS组HBL随时间延长增加（P<0.05），伤后1～3 d TXA组HBL均小于NS组（P<0.05）；2组伤后输血率比较差异有统计学意义（P<0.05），2组患者下肢静脉血栓发生率差异无统计学意义（P>0.05）。结论： 老年骨质疏松性股骨远端骨折患者伤后存在不容忽视的HBL，而伤后早期（≤6 h）TXA干预可有效降低患者伤后HBL及输血率，且并不会增加深静脉血栓发生率，安全可行。

Abstract:

Objective: To evaluate the efficacy and safety of early tranexamic acid (TXA) intervention in reducing hidden blood loss (HBL) after osteoporotic distal femoral fracture. Methods: Retrospective analysis was performed. Elderly patients with osteoporotic distal femoral fracture (≥65 years old) admitted to our hospital from October 2018 to October 2020 were collected as the research subjects, and they were divided into TXA group (October 2018 to October 2019) and NS group (October 2019 to October 2020) according to the time of admission. TXA group was given 2 g of TXA intravenous infusion immediately after admission, and NS group was given the same amount of NS intravenous infusion immediately after admission. The general data, changes of hemoglobin (HGB), hematocrit (HCT) and HBL 1-3 days after trauma, the rate of blood transfusion and the incidence of deep vein thrombosis/pulmonary embolism were analyzed and compared between the two groups. Results: A total of 87 patients were included, including 45 cases in TXA group and 42 cases in NS group. There were no statistically significant differences in general data between the two groups (P>0.05). The levels of HGB and HCT in TXA group and NS group 1-3 days after trauma decreased with the time extension after admission (P<0.05). The level of HGB in TXA group was higher than that in NS group 2 and 3 days after injury (P<0.05), and the level of HCT in TXA group was lower than that in NS group 1-3 days after injury (P<0.05). HBL in TXA group and NS group increased with time prolongation 1-3 days after injury (P<0.05). HBL in TXA group was lower than that in NS group 1-3 days after injury (P<0.05). There were statistically significant differences in the rate of blood transfusion after injury between the two groups (P<0.05), and there was no statistically significant difference in the incidence of venous thrombosis in lower extremity between the two groups (P>0.05). Conclusion: In elderly patients with osteoporotic distal femoral fracture, hidden blood loss can’t be ignored after injury. Early post-injury (≤6 h) TXA intervention can effectively reduce the amount of hidden blood loss and blood transfusion rate, and does not increase the incidence of deep vein thrombosis, which is safe and feasible.