Résumé
BACKGROUND:Intertrochanteric fracture of femur often occurs in the elderly,and there will be a large amount of hidden blood loss after surgery.Reducing hidden blood loss can decrease complications and hospital stay. OBJECTIVE:To evaluate the effect of prolonged use of tranexamic acid on hidden blood loss after proximal femoral nail antirotation implantation in senile intertrochanteric fractures. METHODS:From January 2022 to May 2023,62 elderly admitted patients with intertrochanteric fracture of femur were selected from Zigong Fourth People's Hospital.All of them were treated with proximal femoral nail antirotation implantation after closed reduction on the traction bed.According to the use time of tranexamic acid,they were divided into two groups.In the control group(n=38),1 g tranexamic acid was given intravenically 15-30 minutes before incision,and 1 g was added 3 hours later.Based on the control group,the trial group(n=24)was given 1 g tranexamic acid intravenously once for 12 hours on the first day after surgery.Blood routine examinations were performed before surgery,on the day after surgery,and on the first,third and fifth days after surgery.Hemoglobin and hematocrit were counted.The theoretical total blood loss was calculated by Cross equation,and the incidence of complications in the two groups was recorded. RESULTS AND CONCLUSION:(1)Through statistical analysis,there was no significant difference in the amount of dominant blood loss between the two groups(P>0.05).(2)The number of grams of hemoglobin decreased,total blood loss and hidden blood loss in the trial group during perioperative period were lower than those in the control group,and the differences were statistically significant(P<0.05).(3)The hemoglobin values of the trial group on day 3 after surgery,and the hematocrit values on days 1 and 3 after surgery were higher than those of the control group,with statistical significance(P<0.05).(4)The hemoglobin and platelet count showed a downward trend after surgery,and the hemoglobin value was the lowest value on day 3,and the platelet value was the lowest value on day 1 after surgery,and then began to rise in both groups.(5)There was no significant difference in postoperative complications between the two groups(P>0.05).(6)The results show that prolonging use of tranatemic acid can effectively reduce the hidden blood loss in the treatment of femoral intertrochanteric fracture with proximal anti-rotation intramedullary nail,and does not increase the risk of complications.
Résumé
Objective To observe the effects of continuous blood purification(CBP) combined with early enteral nutrition (EEN) in the treatment of acute severe acute pancreatitis(SAP) complicating hyperlipidemia.Methods Fifty-six cases of acute SAP complicating hyperlipidemia in our hospital from January 2014 to October 2015 were selected as the research subjects and divided into the CBP plus EEN group(combined group) and blood purification(BP) group according to the random digital table method,28 cases in each group.The CBP group was treated with CBP,while on the basis of CBP group the combined group was combined with EEN therapy (within 2 d after admission).The clinical efficacy and the improvement situation of various indexes after treatment were observed in the two groups.Results After treatment,the total effective rate in the combined group was 96.43 ％,which was higher than 75％ in the CBP group,the difference was statistically significant (P＜0.05);the related indicators of TG,UAMY,LPS,SAMY,CRP and LDH after treatment in the two groups were decreased,but which in the combined group were more significant compared with the CBP group(P＜0.05).After treatment,the APACHE-[[score in the combined group was significantly lower than that in the CBP group(P＜0.05),the symptom relief time and hospital stay time in the combined group were shorter than those in the CBP group (P＜0.05).The incidence rate of complications in the combined group was 10.71％,which was significantly lower than 28.57％ in the CBP group,the difference was statistically significant(P＜0.05).Conclusion CBP combined with EEN can significantly improve the prognosis of SAP patients and effectively reduces the complications.
Résumé
Objective:To study the effect of continuous blood purification on inflammatory state and immune response in patients with multiple injury and sepsis.Methods:88 patients with multiple injury and sepsis who were treated in our hospital from January 2015 to May 2016 were selected as the research object,they were divided into the control group (n=44) and observation group (n=44) according to random number table method.The control group was given conventional treatment,and the observation group was given continuous blood purification treatment.The acute physiology and chronic health conditions Ⅱ (APACHE Ⅱ)score was observed in two groups Ⅱ at 3 d after treatment.The serum content of Interleukin-2(IL-2),Interleukin-4(IL-4),Interleukin-10(IL-10) and interferon-γ (IFN-γ) were detected by ELISA method.The levels of CD3 +,CD4 +,CD8 + and NK cell were analyzed by flow cytometry.The urea nitrogen (BUN),serum creatinine (Scr),prothrombin time (PT),thrombin time (TT),activated partial blood coagulation time (APTT) were tested by automatic biochemical analyzer.Results:The APACHE Ⅱ score,BUN and Scr levels in observation group were lower than the control group (P＜0.05).The content ofIL-2,IL-4,IL-10 and IFN-γ in observation group were lower than the control group (P＜0.05).The levels of CD3+,CD4+,CD8+ and NK in observation group were higher than the control group (P＜0.05).The levels ofPT,TT and APTT in observation group were lower than the control group (P＜0.05).Conclusion:Continuous blood purification in patients with multiple injury and sepsis had better clinical curative effect,can reduce inflammation,improve immune function and the function of blood coagulation.