| 血栓弹力图评价老年股骨颈骨折患者围手术期应用大剂量氨甲环酸安全性及有效性的定量研究 |
| A quantitative study on the safety and efficacy of perioperative high-dose tranexamic acid in elderly patients with femoral neck fractures evaluated by TEG |
| 投稿时间：2025-01-13 |
| DOI：10.3969/j.issn.1672-5972.2026.04.007 |
| 中文关键词: 血栓弹力图（TEG） 氨甲环酸 股骨颈骨折 |
| 英文关键词:Tthromboelastography (TEG) Tranexamic acid Femoral neck fracture |
| 基金项目:四川省医学会（恒瑞）专项课题（2021HR66） |
| 作者 | 单位 | 邮编 | | 赫明亮* | 成都医学院附属第二医院（核工业四一六医院）骨科,四川 成都,610000 | 610000 | | 严钰皓 | 成都医学院附属第二医院（核工业四一六医院）骨科,四川 成都,610000 | 610000 | | 包利帅 | 成都医学院附属第二医院（核工业四一六医院）骨科,四川 成都,610000 | 610000 | | 刘选泽 | 成都医学院附属第二医院（核工业四一六医院）骨科,四川 成都,610000 | 610000 | | 肖国庆* | 成都医学院附属第二医院（核工业四一六医院）骨科,四川 成都,610000 | 610000 |
|
| 摘要点击次数: 12 |
| 全文下载次数: 2 |
| 中文摘要: |
| 目的 探究血栓弹力图（thromboelastography, TEG）定量评价老年股骨颈骨折患者围手术期应用大剂量氨甲环酸的安全性及有效性。方法 选择2021年12月至2024年9月在成都医学院附属第二医院骨科接受人工股骨头置换术的股骨颈骨折患者210例作为研究对象，随机分为7组，每组30例，其中试验组为A、B、C、D、E、F组，另外一组为对照组，不予氨甲环酸注射。A组术前按20 mg/kg静脉给予首剂，每隔3 h追加剂量10 mg/kg，共追加2次；B组术前按20 mg/kg静脉给予首剂，每隔3 h追加剂量20 mg/kg，共追加2次；C组术前按20 mg/kg静脉给予首剂，之后24 h追加5次，前2次间隔3 h，后3次间隔6 h，追加剂量10 mg/kg；D组术前按40 mg/kg静脉给予首剂，之后不追加剂量；E组术前按40 mg/kg静脉给予首剂，每隔3 h追加剂量10 mg/kg，共追加2次；F组术前按60 mg/kg静脉给予首剂，每隔3 h追加剂量10 mg/kg，共追加2次。比较各组在术后3 d的血栓弹力图参数、失血量、输血率、血栓发生率等。结果 总失血量方面，试验组相较对照组减少，差异具有统计学意义（P＜0.05）。7组患者输血及DVT发生率差异无统计学意义（P＞0.05）。对照组TEG各参数均在正常范围；与对照组比较，试验组术后3 d时A、B、C、D、E组R值降低，差异有统计学意义（P＜0.05），F组差异则无统计学意义（P＞0.05）。与对照组比较，试验组α角、MA均上升，差异有统计学意义（P＜0.05）。各试验组与对照组K值差异无统计学意义（P＞0.05）。B、C、E、F组CI值高于对照组，差异有统计学意义（P＜0.05），A、D组与对照组相比，差异无统计学意义（P＞0.05）。结论 大剂量氨甲环酸序贯治疗可有效减少失血量，且不同剂量组围手术期的凝血功能状态无明显差异。 |
| 英文摘要: |
| Objective To explore the safety and efficacy of thromboelastography (TEG) in quantitatively evaluating the perioperative application of high-dose tranexamic acid in elderly patients with femoral neck fractures.Methods Patients with femoral neck fractures who underwent artificial femoral head replacement in the department of orthopedics, the Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital) from December 2021 to September 2024 were selected as the research subjects. They were randomly divided into 7 groups, with 30 cases in each group. The experimental groups were groups A, B, C, D, E, and F, while the remaining group was the control group, which did not receive tranexamic acid injection. In group A, the initial dose of 20 mg/kg was intravenously administered before surgery, and a supplementary dose of 10 mg/kg was given every 3 hours for a total of two times. In group B, the initial dose of 20 mg/kg was intravenously administered before surgery, and a supplementary dose of 20 mg/kg was given every 3 hours for a total of two times. In group C, the initial dose of 20 mg/kg was intravenously administered before surgery, and then a supplementary dose of 10 mg/kg was given 5 times within 24 hours. The first two supplementary doses were given at 3 - hour intervals, and the last three were given at 6 - hour intervals. In group D, the initial dose of 40 mg/kg was intravenously administered before surgery, with no supplementary dose thereafter. In group E, the initial dose of 40 mg/kg was intravenously administered before surgery, and a supplementary dose of 10 mg/kg was given every 3 hours for a total of two times. In group F, the initial dose of 60 mg/kg was intravenously administered before surgery, and a supplementary dose of 10 mg/kg was given every 3 hours for a total of two times. One group served as the control group, in which no tranexamic acid was injected. The TEG parameters, blood loss volume, transfusion rate, and thrombosis incidence of each group were compared on the third day after surgery.Results In terms of total blood loss, the experimental group showed a significantly lower amount compared to the control group (P<0.05). However, there was no statistically significant difference in the blood transfusion rate and the incidence of DVT among the 7 groups of patients (P>0.05). All parameters of TEG in the control group were within the normal range; compared with the control group, the R values of groups A, B, C, D, and E in the experimental group were significantly lower on the third day after surgery (P<0.05), while there was no significant difference in group F (P>0.05). Compared with the control group, the α angle and MA in the experimental group increased significantly, with statistically significant differences (P<0.05). There was no significant difference in the K value between the experimental groups and the control group (P>0.05). The CI values of groups B, C, E, and F were significantly higher than those of the control group (P<0.05), while there was no significant difference in groups A and D (P>0.05).Conclusion Sequential treatment with high-dose tranexamic acid can effectively reduce blood loss volume, and there is no significant difference in the perioperative coagulation function status among different dose groups. |
| 查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
