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Objective To investigate the effect of intraoperative dripping of intravenous tranexamic acid (TXA) on the perioperative blood loss in elderly patients undergoing hip arthroplasty for femoral neck fracture.Methods From January 2016 to August 2017,118 elderly patients with femoral neck fracture were treated with hip arthroplasty at Department of Orthopaedics,China-Japan Friendship Hospital.They were 45 males and 73 females,with an average age of 77.1 years.Of them,60 (TXA group) were subjected to intravenous TXA dripping over 10 minutes by 2 doses (15 mg/kg TXA dissolved in 100 mL of saline) with the first dose before incision and the second one at wound closure;58 (control group) were subjected to intravenous administration of 100 mL of saline solution in a similar fashion.Blood routine tests were carried out one day before operation,and the first and third days after operation.The transfusion rate and volume,and surgical blood loss were recorded.The total blood loss on postoperative 1-day and 3-day were calculated according to hemoglobin balance method.The 2 groups were compared in terms of blood loss and complications.Results The blood transfusion rate (21.7％),blood transfusion volume (310.8 ± 85.7 mL),surgical blood loss (424.3 ± 87.6 mL),total blood loss on postoperative 1-day (1,284.6 ±288.7 mL) and total blood loss on postoperative 3-day (1,501.2 ± 337.1 mL) in the TXA group were all significantly lower than those in the control group (41.4％,379.8 ± 110.2 mL,526.7 ± 113.8 mL,1,534.8 ± 279.2 mL and 1,887.4 ± 431.8 mL,respectively) (P ＜ 0.05).There was no significant difference between the 2 groups in postoperative complications (P ＞ 0.05).Conclusion In elderly patients undergoing hip arthroplasty for femoral neck fracture,intravenous TXA administration may lower transfusion rate,reduce transfusion volume,and decrease surgical blood loss and postoperative total blood loss without increasing the risks of surgery-related complications like thrombosis.
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Objective To analyze the risk factors associated with periprosthetic femoral fracture following hemiarthroplasty (HA) for displaced femoral neck fracture in aged patients.Methods From January 2013 to June 2016,120 patients over 80 years old were treated by HA for displaced femoral neck fractures.They were 45 males and 75 females,with an average age of 85.2 years (from 80 to 97 years).Their fractures were Garden type Ⅲ (72 cases) and Garden type Ⅳ (48 cases).The time from injury to operation averaged 5.1 days.The patients were divided into a fracture group and a non-fracture group according to the presence or absence of the periprosthetic fracture.The general data of the 2 groups were compared;multivariate logistic regression analyses were done to indentify the influencing factors associated with periprosthetic femoral fracture.Results The 120 patients obtained a mean follow-up of 26.1 months (from 13 to 48 months).Periprosthetic femoral fracture occurred in 11 cases,giving an overall incidence of 9.2％ (11/120).Compared with the non-fracture group,the average age was significantly older,the incidence of past fractures was significantly higher,significantly more types of uncemented stem were used,and American Society of Anesthesiologists (ASA) grading was significantly more severe for the fracture group (P ＜ 0.05).There were no significant differences between the 2 groups concerning the general data (P ＞ 0.05).Multivariate Logistic regression analyses revealed that age [OR =1.268,95％ CI (1.059,1.517),P =0.010] and type ofuncemented stem [OR =0.072,95％ CI (0.008,0.625),P =0.017] were independent risk factors for periprosthetic fracture.Conclusions The incidence of periprosthetic femoral fracture in the elderly patients may be high following HA for femoral neck fractures.Since age and uncemented stem may be independent risk factors for periprosthetic femoral fracture,surgeons should pay enough attention to them in clinic.
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Objective To evaluate the therapeutic effects of noninvasive bi-level positive airway pressure (BiPAP) ventilation after extubation in chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods Forty-one intubated COPD eases with severe respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study.At the time of pulmonary infection control (PIC) window,the extubation was conducted and followed by BiPAP ventilation in 21 cases (the experimental group),while the other 20 COPD cases with similar clinical characteristics,as the control group,who continuously received invasive mechanical ventilation after PIC window.Outcomes including the duration of invasive ventilation,the total duration of ventilation support,success rate,the incidence of ventilator associated pneumonia (VAP) and mortality rate were observed and compared between the two groups.Results The two groups had similar clinical characteristics and gas exchange at the time of PIC window (P ＞ 0.05 ).Compared with the control group,the experimental group had shorter duration of invasive mechanical ventilation (6.9±3.0) d vs.(13.1 ±4.3) d,t=5.38,P＜0.001),lower rate of VAP (1/20 vs.8/20,x2 =5.51,P=0.02) andhigher extubation rate (20/21 vs.13/20,x2 =4.19,P =0.04).Conclusion In COPD patients with intubation and mechanical ventilation for respiratory failure,BiPAP ventilation after extubation at the point of PIC window may improve patients' prognosis.