The Clinical Application Of Pingle Guo’s Prescription Combined With Different Ways Of Administering Tranexamic Acid In The Perioperative Period Of PFNA Internal Fixation For Intertrochanteric Fractures Of The Elderly

ObjectiveThis study aimed to explore the hemostatic effect of intravenous drip and intravenous drip combined with local use of tranexamic acid(TXA)in the perioperative period of PFNA internal fixation for intertrochanteric fractures of the elderly.At the same time,we observed the effect of Pingle Guo’s prescription-HongtaoXiaozhong Mixture on perioperative blood loss during PFNA internal fixation for intertrochanteric fractures of the elderly.It provides a clinical basis for the better way of tranexamic acid medication in the perioperative period of PFNA for elderly intertrochanteric fractures and the combination of traditional Chinese and Western medicine.MethodsThis study selected the patients who were admitted to Shenzhen Pingle Orthopedics Hospital(Shenzhen Pingshan Hospital of Traditional Chinese Medicine)from June 2019 to January 2021 and received Proximal femoral nail antirotation(Proximal femoral nail antirotationfor intertrochanteric fractures.PFNA)120 elderly patients treated with surgery were taken as the research objects.120 patients were randomly divided into four groups(venous group,combined group,vein+red peach group,combined+red peach group)according to the order of admission,30 patients in each group.Intravenous group:intravenous drip of tranexamic acid injection 15mg/kg+100ml normal saline 30 minutes before surgical skin incision.Combination group:Tranexamic acid injection 15mg/kg+100ml normal saline was injected intravenously 30 minutes before surgical skin incision,2g tranexamic acid injection was mixed into absorbable hemostatic cotton gauze and placed in the incision before closing the incision.Intravenous+red peach group:oral administration of HongtaoXiaozhong Mixture 2 days before surgery to 7 days after surgery,intravenous drip of tranexamic acid injection 15mg/kg+100ml normal saline 30 minutes before surgical skin incision.Combination+red peach group:Oral HongtaoXiaozhongMixture was administered 2 days before the operation to the 7th day after the operation.Tranexamic acid injection 15mg/kg+100ml normal saline was injected intravenously 30 minutes before surgical skin incision.Before closing the incision,mix 2 g of tranexamic acid injection into absorbable hemostatic cotton gauze and put it into the incision.Before surgery,record the patient’s gender,age,height,weight,time from injury to surgery,affected side,hemoglobin(Hb)and hematocrit(Hematoric,Hct)1 day before surgery as a baseline comparison.Strictly check and record the changes in hemoglobin,hematocrit and intraoperative blood loss at 1,3,and 7 days after surgery.We use the Cross equation to calculate postoperative hidden blood loss,compare the changes in Hb and Hct values,dominant blood loss,hidden blood loss,total blood loss,blood transfusion rate,etc.between the two groups on 1,3,and 7 days,and record whether there is any Occurrence of serious adverse events.ResultsConclusionA total of 108 patients were enrolled in this study(27 cases in the combination+red peach group,29 cases in the combined application group,24 cases in the vein+red peach group,28 cases in the vein group).By comparing the gender,age,affected side,fracture type,fracture to operation time,operation time,anesthesia method and Hct and Hb before operation,the baseline of the four groups of patients was balanced and comparable(P>0.05).The total blood loss,hidden blood loss,hemoglobin(Hb)difference and hematocrit(Hct)difference between the venous group and the combined group were compared.The difference in hemoglobin and hematocrit difference between the 3rd day after the operation and the 1st day after the operation in the intravenous group and the combined group were compared.Compare the hemoglobin difference,hematocrit difference and blood transfusion rate between the 7th day and the 3rd day after the operation in the intravenous group and the combined group.The total blood loss,hidden blood loss,intraoperative blood loss,and blood transfusion rate of patients in the vein group and vein+heart group were compared,and the results showed that there was no significant difference in the data between the two groups(P>0.05).The total blood loss,hidden blood loss,intraoperative blood loss,and blood transfusion rate of patients in the vein group and vein+heart group were compared,and the results showed that there was no significant difference in the data between the two groups(P>0.05).