The Effect Of Different Administration Timing Of Tranexamic Acid On Hidden Blood Loss In The Postoperative Patients With Intertrochanteric Femoral Fractures

ObjectiveThis study explored the effect of different administration timing of tranexamic acid(TXA)by intravenous infusion on hidden blood loss in the postoperative patients with intertrochanteric femoral fractures treated by proximal femoral nail antirotation(PFNA),and explored the more effective dose regimen of TXA.MethodsFrom July 2017 to February 2019,we chose the patient with femoral intertrochanteric fracture(IFF)in the Department of Traumatic Orthopaedics,Guangdong Hospital of TCM.All patients were treated with PFNA.A total of 60 cases,randomly divided into experimental group and control group 30 cases.The experimental group received 10 mg/kg TXA by intravenous drip 25 minutes before operation,and did it again before reaming.The control group received 10 mg/kg TXA by intravenous drip 50 minutes before operation,and no TXA was used for the rest of the time.These two groups were recorded the gender,age,weight,height,limb position,basic diseases,AO type of fracture,days from trauma to operation,Hb and Hct before surgery,preoperative blood volume,preoperative nutritional status,dominant blood loss in surgery,operation time,Tip-apex distance,Hb and Hct on the first day,third day,and seventh day after surgery.At last,we calculate the amount of hidden blood loss and compare the differences between the two groups.ResultsA total of 60 IFF patients(30 in the combined group and 30 in the preoperative group)were enrolled in this study,including 18 males(10 in the combined group and 8 in the preoperative group)and 42 females(20 in the combined group and 22 in the preoperative group).The average age was 76.57±5.57 years(76.93±5.09 years in the combined group and 76.20±6.09 years in the preoperative group).Among them,there were 30 cases of hypertension(17 cases in the combined group,13 cases in the preoperative group),12 cases of diabetes(7 cases in the combined group,5 cases in the preoperative group),6 cases of cerebral infarction(3 cases in the combined group,3 cases in the preoperative group),10 cases of coronary heart disease(5 cases in the combined group,5 cases in the preoperative group),and 6 cases of chronic obstructive pulmonary disease(3 cases in the combined group and 3 cases in the preoperative group).There were no significant differences in gender,age,limb position,basic diseases,AO type of fracture,weight,height,days from trauma to operation,preoperative nutritional status,preoperative blood volume,operation time,Tip-apex distance,Hb and Hct before surgery and anesthesia methods between the combined group and the preoperative group(P>0.05).Within-group comparison:the levels of Hb and Hct on the first day after operation in the preoperative group were significantly lower than those of the preoperative group(P<0.05).The levels of Hb and Hct on the first day after operation in the combined group were not significantly different from those of the preoperative group(P>0.05).The levels of Hb and Hct on the third day after operation in the combined group were not significantly different from those on the first day after operation(P>0.05).The levels of Hb and Hct on the third day after operation in the preoperative group were not significantly different from those on the first day after operation(P>0.05).The levels of Hb and Hct on the seventh day after operation in the combined group were not significantly different from those on the third day after operation(P>0.05).The levels of Hb and Hct on the seventh day after operation in the combined group were not significantly different from those on the third day after operation(P>0.05).Between-group comparison:there was no significant difference in preoperative Hb and Hct levels between the two groups(P>0.05);the levels of Hb and Hct in the preoperative group on the first day after operation were significantly lower than those in the combined group on the first day after operation(P<0.05);the levels of Hb and Hct in the preoperative group on the third day after operation were significantly lower than those in the combined group on the third day after operation(P<0.05).The levels of Hb and Hct in the preoperative group on the seventh day after operation were significantly lower than those in the combined group on the seventh day after operation(P<0.05).The results of repeated measurements of variance analysis showed that the levels of Hb and Hct in the two groups decreased from preoperation to the third day after operation,and the decrease range was different.The decrease range of Hb and Hct in the preoperative group was the largest from the preoperation to the first day after operation.Compared with the preoperative group,the decrease range of Hb and Hct levels in the combined group was smaller from preoperation to the first day before operation.The hidden blood loss and total blood loss in the combined group were significantly lower than those in the preoperative group(P<0.05).There was no significant difference in blood transfusion rate between the two groups(P>0.05).ConclusionCompared with the changes of Hb and Hct levels in preoperative group and combined group during perioperative period,combined intravenous drip of TXA before and during operation can more effectively control the occult blood loss and total blood loss of IFF patients after PFNA,and effectively control the anemia of patients.