Influence of postoperative intravenous infusion of tranexamic acid on perioperative blood loss in elderly patients with femoral intertrochanteric fractures treated with proximal femoral nail antirotation / 中华创伤杂志

ABSTRACT

Objective To evaluate the effect and safety of postoperative intravenous infusion of tranexamic acid on the perioperative blood loss in elderly patients with femoral intertrochanteric fractures treated with proximal femoral nail antirotation.Methods A retrospective case-control study was conducted on 60 aged patients with unilateral intertrochanteric fracture who were treated with proximate femoral nail annotation from January 2015 to March 2017.Patients were divided into two groups according to method of administration,with 30 cases in each group.Patients in the single administration group were given 15 mg per kilogram of tranexamic acid 20 minutes before surgery by intravenous drip (Group A),whereas patients in the twice administration group were given 15 mg per kilogram 20 minutes before surgery and 1 g 7 hours later by intravenous drip (Group B).There were 11 males and 19 females in Group A,with the age of (78.57 ±7.60)years.Group B included 12 males and 18 females,and the age was (76.80 ± 7.90) years.Perioperative data including operation time,intraoperative blood loss,total blood loss,recessive blood loss,postoperative drainage volume,mean blood transfusion volume,blood transfusion rate,maximum hemoglobin drop after surgery,and postoperative hospitalization time as well as complications including deep vein thrombosis,pulmonary embolism,wound infection,intermuscular venous thrombosis,exudate,hematoma,fat liquefaction were compared between the two groups.Results The operation time was (85.00 ± 19.17)minutes in Group A and (81.10 ± 19.23)minutes in Group B (P ＞ 0.05).The intraoperative blood loss was (113.33 ± 56.77) ml in Group A and (129.33 ± 93.70) ml in Group B (P ＞ 0.05).The total blood loss was (748.47 ± 246.71) ml in Group A and (477.83 ± 213.78) ml in Group B (P ＜ 0.05).The recessive blood loss was (715.00 ± 289.48) ml in Group A and (357.00 ± 237.54) ml in Group B (P ＜ 0.05).The postoperative drainage volume was (58.50 ±32.22)ml in Group A and (29.83 ± 13.03)ml in Group B (P ＜0.05).The blood transfusion was O(0,200)ml in Group A and 0(0,0)ml in Group B (P ＜0.05).The blood transfusion rate was 33％ (10/30) in Group A and 7％ (2/30) in Group B (P ＜0.05).The maximum hemoglobin drop after surgery was (25.5 ±6.5)g/L in Group A and (17.4 ±5.1)g/L in Group B (P＜O.05).The postoperative hospitalization time was (7.30 ± 1.26) days in Group A and (5.53 ± 0.73) days in Group B (P ＜ 0.05).Moreover,no deep vein thrombosis,pulmonary embolism or wound infection occurred in either group.There were no significant differences in the incidence of intramuscular venous thrombosis,exudate,hematoma or fat liquefaction between the two groups (P ＞ 0.05).Conclusion Compared with the single administration of tranexamic acid,the twice administration is more effective in controlling perioperative blood loss,which is worthy of clinical application.