Sj Karthik, Ethiraj Prabhu, Shanthappa Arun H, Vellingiri Kishore
Department of Orthopedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND.
Cureus. 2022 Jan 14;14(1):e21249. doi: 10.7759/cureus.21249. eCollection 2022 Jan.
Background The incidence of hip fractures is increasing in the current population. It is estimated by the year 2050 around 6.3 million hip fractures may occur per year. Management of hip fractures and replacement surgeries might be associated with substantial blood loss which leads to perioperative anemia. Tranexamic acid is an antifibrinolytic agent that has evidence of reducing blood loss during arthroplasty surgeries. This study aims to evaluate the efficacy and safety of tranexamic acid in patients undergoing hip surgeries. Materials and methods This is a cross-sectional study of the patients during the period of May 2020 to April 2021. Forty-eight patients who underwent hip surgery during this period were taken up for the study. Patients were divided into the following groups: group T (n=24) and group P (n=24). Group T received tranexamic acid 10 mg/kg intravenously, as a bolus slowly, 30 minutes prior to skin incision and 1 mg/kg/h intravenous infusion till the closure of skin incision. Group P received normal saline 0.1 ml/kg intravenously, as a bolus slowly, 30 minutes prior to skin incision, and then 1 ml/kg/h intravenous infusion till the skin closure. The primary outcome measured was the total blood loss using Gross and Nadel formulaand the secondary outcomes measured were packed red blood cell (PRBC) transfusion requirement, length of hospital stay, drop-in hematocrit value, ambulation time, and incidence of any other adverse event between the two groups. Results The total blood loss in group T patients was 474.12 (± 90.35) ml and in group P was 647.41 (± 114.58) ml, the p-value was <0.001 which was statistically significant. The overall PRBC transfusion rate was 75% (18 patients) in group P and 37.5% (nine patients) in group T with a p-value of 0.020. Nine (37.5%) patients included in group T began to ambulate within 24 hours of surgery while six patients in group P were ambulated within 24 hours with a p-value of <0.001. Conclusion Preoperative infusion of tranexamic acid is effective in reducing intraoperative blood loss and blood transfusion requirement rates. It is also safe and efficacious in patients undergoing hip surgeries.
背景 目前人群中髋部骨折的发生率正在上升。据估计，到2050年，每年可能发生约630万例髋部骨折。髋部骨折的治疗和置换手术可能会导致大量失血，进而导致围手术期贫血。氨甲环酸是一种抗纤维蛋白溶解剂，有证据表明其可减少关节置换手术中的失血。本研究旨在评估氨甲环酸在接受髋关节手术患者中的疗效和安全性。
材料和方法 这是一项对2020年5月至2021年4月期间患者的横断面研究。选取在此期间接受髋关节手术的48例患者进行研究。患者分为以下两组：T组（n = 24）和P组（n = 24）。T组在皮肤切开前30分钟缓慢静脉推注氨甲环酸10 mg/kg，然后以1 mg/kg/h的速度静脉输注直至皮肤切口关闭。P组在皮肤切开前30分钟缓慢静脉推注0.1 ml/kg生理盐水，然后以1 ml/kg/h的速度静脉输注直至皮肤关闭。测量的主要结局是使用Gross和Nadel公式计算的总失血量，测量的次要结局是浓缩红细胞（PRBC）输注需求、住院时间、血细胞比容值下降、行走时间以及两组之间任何其他不良事件的发生率。
结果 T组患者的总失血量为474.12（±90.35）ml，P组为647.41（±114.58）ml，p值<0.001，具有统计学意义。P组的总体PRBC输注率为75%（18例患者），T组为37.5%（9例患者），p值为0.020。T组中有9例（37.5%）患者在手术后24小时内开始行走，而P组中有6例患者在24小时内行走，p值< 0.001。
结论 术前输注氨甲环酸可有效减少术中失血量和输血需求率。对于接受髋关节手术的患者，它也是安全有效的。
