本文選題：氨甲環(huán)酸　切入點(diǎn)：轉(zhuǎn)子間　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:隨著人類逐漸步入老齡化社會(huì),老年轉(zhuǎn)子間骨折發(fā)病率呈逐年上升的趨勢。股骨近端防旋髓內(nèi)釘(PFNA)是目前治療轉(zhuǎn)子間骨折的首選方法。但PFNA術(shù)后常常存在較大隱性失血。由隱性失血導(dǎo)致的貧血如不及時(shí)糾正,將影響傷口愈合,延長住院時(shí)間,增加患者術(shù)后肺水腫、腦水腫的發(fā)生率。為糾正隱性失血往往要進(jìn)行輸血,而輸血存在傳播疾病,導(dǎo)致輸血相關(guān)性肺損傷,移植物抗宿主病等并發(fā)癥的風(fēng)險(xiǎn)。氨甲環(huán)酸作為傳統(tǒng)的抗纖溶藥物,能與纖溶酶和纖溶酶原上的賴氨酸結(jié)合部位相結(jié)合,抑制了纖溶酶和纖溶酶原的活性,從而阻止了纖維蛋白的分解而發(fā)揮抗纖溶作用。文獻(xiàn)報(bào)道氨甲環(huán)酸能夠顯著減少心臟、肝臟及婦產(chǎn)科手術(shù)的出血量。在骨科領(lǐng)域,氨甲環(huán)酸主要用于減少髖、膝關(guān)節(jié)置換和脊柱手術(shù)的出血量及降低輸血率,但目前尚無研究關(guān)于氨甲環(huán)酸對(duì)老年轉(zhuǎn)子間骨折術(shù)后隱性失血影響的報(bào)道。本實(shí)驗(yàn)旨在評(píng)估氨甲環(huán)酸對(duì)老年轉(zhuǎn)子間骨折髓內(nèi)釘固定術(shù)后隱性失血的影響。方法:自2016年1月~2017年1月期間,我院共治療符合納入標(biāo)準(zhǔn)的老年轉(zhuǎn)子間骨折患者100例,按隨機(jī)數(shù)字表法隨機(jī)分為實(shí)驗(yàn)組和對(duì)照組,每組50例。實(shí)驗(yàn)組男性19例,女性31例;平均年齡77.74±6.53歲,身高1.63±0.08米,體重64.37±12.88千克。按AO/OTA分型:A1型24例,A2型19例,A3型7例。按ASA分級(jí):Ⅰ級(jí)9例,Ⅱ級(jí)29例,Ⅲ級(jí)12例。全部采用PFNA進(jìn)行固定,且氨甲環(huán)酸10 mg.kg-1術(shù)前10分鐘及術(shù)后5小時(shí)各靜點(diǎn)一次。對(duì)照組男性14例,女性36例;平均年齡79.25±6.55歲,身高1.60±0.08米,體重59.03±11.68千克。按AO/OTA分型:A1型29例,A2型15例,A3型6例。按ASA分級(jí):Ⅰ級(jí)9例,Ⅱ級(jí)23例,Ⅲ級(jí)18例。治療方法與實(shí)驗(yàn)組相同,但不應(yīng)用氨甲環(huán)酸。所有患者術(shù)日8:00行血常規(guī)檢查,記錄術(shù)中失血、術(shù)后引流及術(shù)后輸血量,術(shù)后第2天8:00復(fù)查血常規(guī)。按Gross方程分別計(jì)算兩組患者的總失血量和隱性失血量。所有患者術(shù)前及術(shù)后1周行雙下肢深靜脈超聲檢查,記錄血栓發(fā)生情況。所有均數(shù)用(?)±S表示,數(shù)據(jù)應(yīng)用SPSS 21.0軟件作統(tǒng)計(jì)處理,計(jì)數(shù)資料采用t檢驗(yàn),計(jì)量資料采用χ2檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:實(shí)驗(yàn)組術(shù)中失血量為(73.25±30.22)ml,術(shù)后引流量為(40.09±16.54)ml,顯性失血量(術(shù)中失血量+術(shù)后引流量)為(113.34±75.82)ml,總失血量為(515.30±278.79)ml,隱性失血量為(401.96±260.72)ml。共有24人進(jìn)行輸血,平均輸血量為(160±71.73)ml,輸血率為48.0%。對(duì)照組術(shù)中失血量為(107.43±33.29)ml,術(shù)后引流量為(56.86±20.20)ml,顯性失血量為(164.29±88.052)ml,總失血量為(696.88±275.00)ml,隱性失血量為(532.60±253.41)ml。共有34人進(jìn)行輸血,平均輸血量為(270±109.41)ml,輸血率為68.0%。經(jīng)統(tǒng)計(jì)學(xué)分析,實(shí)驗(yàn)組的顯性失血量、總失血量、隱性失血量、輸血量及輸血率均低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組中使用短釘固定的患者比長釘者隱性失血減少了123.04ml,差異有統(tǒng)計(jì)學(xué)意義(P=0.024);對(duì)照組中使用短釘固定的患者比長釘者隱性失血減少了142.53ml,差異有統(tǒng)計(jì)學(xué)意義(P=0.016)。兩組患者術(shù)后一周下肢深靜脈血栓的發(fā)生率無統(tǒng)計(jì)學(xué)差異(P=0.938)。結(jié)論:氨甲環(huán)酸能減少老年轉(zhuǎn)子間骨折髓內(nèi)釘固定術(shù)后的隱性失血量,且不增加發(fā)生雙下肢深靜脈血栓的風(fēng)險(xiǎn)。
[Abstract]:Objective: with the development of mankind has gradually entered the aging society, the elderly intertrochanteric fracture incidence increased year by year. The proximal femoral nail anti rotation (PFNA) is currently the preferred method of treatment of intertrochanteric fractures. But after PFNA often there is a big hidden blood loss. Hidden blood loss caused by anemia if not corrected the effect of wound healing, prolonged hospitalization, postoperative pulmonary edema increased, the incidence of hemorrhagic brain edema. To correct the recessive often requires blood transfusion, and blood transfusion existence spread disease, cause of transfusion related lung injury, the risk of complications such as graft-versus-host disease. Tranexamic acid as anti fibrinolytic drugs tradition. Can be combined with plasmin and plasminogen on lysine binding sites inhibits plasmin and plasminogen activity, thereby preventing the breakdown of fibrin and play the role of anti fibrinolytic. Tranexamic acid reported in literature. Can significantly reduce the amount of bleeding heart, liver and obstetrics and gynecology surgery. In the Department of orthopedics, tranexamic acid is mainly used to reduce the amount of bleeding of hip, knee joint replacement and spine surgery and decrease the rate of blood transfusion, but there is no research on the effect of tranexamic acid on hidden blood loss for the intertrochanteric fractures in the elderly patients after this experiment reports. To evaluate the effect of tranexamic acid on fixation of hidden blood loss after intramedullary nailing of senile intertrochanteric fracture. Methods: from January 2016 ~2017 January, in our hospital were treated with 100 cases of elderly patients with intertrochanteric fracture of the rotor into the standard, according to the random number table method were randomly divided into experimental group and control group, 50 cases in each group. The experimental group male 19 cases, female 31 cases; mean age 77.74 + 6.53, 1.63 + 0.08 meters height, weight 64.37 + 12.88 kg. According to AO/OTA classification: type A1 24 cases, A2 19 cases, type A3 7 cases. According to ASA classification: 9 cases of grade I, grade II in 29 cases, 12 patients with grade III. 鍏ㄩ儴閲囩敤PFNA榪涜鍥哄畾,涓旀皚鐢茬幆閰，

本文編號(hào)：1636938