| PurposeTo explore the possible influencing factors of occult blood loss in elderly patients with intertrochanteric fracture after closed intramedullary nail fixation,to explore effective preventive measures for occult blood loss in elderly patients with intertrochanteric fracture,and to observe its clinical efficacy and safety,so as to provide relevant basis and suggestions for its clinical application.MethodsFrom January 2017 to December 2018,186 cases of intertrochanteric fracture of femur were treated with closed reduction and intramedullary nail fixation in our hospital.According to the inclusion criteria and exclusion criteria,130 patients were included in the experimental study.Among them,50 cases were in the non-drug experimental group and 80 cases were in the drug experimental group.All patients were examined by blood routine and coagulation routine before,on the first day after operation,on the third day after operation,on the fifth day after operation and on the seventh day after operation,at 6:00 a.m.to record and observe the changes of hemoglobin(Hb),hematocrit(Hct)and hemoglobin content(Hb)< 70g/L.Blood vessel color Doppler ultrasonography was performed before and one week after operation to observe whether there was thrombosis.The experimental data of intraoperative blood loss,postoperative drainage,postoperative blood transfusion,average operation time and incidence of deep venous thrombosis were recorded.All patients calculated the occult blood loss according to Gross linear equation.(1)In the non-drug test group,based on the single factor variable principle,the recessive blood loss of 50 patients was determined by the patient's age,gender,body mass index(BMI),whether or not diabetes,or hypertension.The duration of surgery,Evans classification were independent variables for univariate data analysis and multiple linear regression analysis,and whether there were statistical differences between the factors.Patients were randomized according to the timing of surgery and the length of the main nail in the intramedullary nail.The difference between the recessive blood loss of each group was statistically significant.(2)In the experimental group,patients were randomly divided into blank control group,recombinant human erythropoietin group,tranexamic acid group,tranexamic acid combined with recombinant human erythropoietin group,20 patients in each group.The difference of occult blood loss on the third day and the seventh day after operation in each group was compared.Color Doppler ultrasonography of bilateral lower extremities was performed before operation,one week after operation and before discharge to evaluate and compare the incidence of postoperative complications among the groups.Results(1)There was no significant difference in the mean Hb and Hct between the patients in the non-drug group.There was no statistically significant difference in the amount of recessive blood loss between the groups,gender,BMI,and duration of surgery.The recessive blood loss of the patients older than 75 years was(718.31±107.12)ml,and the recessive blood loss was less than 75 years old(603.56±81.14)ml.There was significant difference between the two groups(P<0.05).The recessive blood loss in patients with hypertension was(678.35±61.29)ml,and the recessive blood loss in patients without hypertension was(622.38±79.56)ml.There was a statistically significant difference between the two groups(P<0.05).Patients with diabetes mellitus The recessive blood loss was(670.37±89.25)ml,and the recessive blood loss of patients without diabetes was(614.06±67.05)ml.There was significant difference between the two groups(P<0.05).Evans type I and II were included.The amount of recessive blood loss was(610.31±90.27)ml,and the amount of recessive blood loss in Evans type III,IV and V group was(701.54±87.18)ml.There was significant difference between the two groups(P<0.05).The invisible blood loss of the immediate operation group was(569.92±76.28)ml 3 days after operation,and the invisible blood loss of the operation group was(638.26±97.67)ml after 3 hours.After statistical analysis,the amount of postoperative recessive blood loss in the immediate surgery group was significantly lower than that in the operation group after 24 hours(P<0.05).The amount of invisible blood loss in the short nail group was(586.40±94.61)ml after 3 days,and the invisible blood loss in the long nail group was(653.75±81.21)ml.After statistical analysis,the amount of recessive blood loss in the short nail group was significantly lower than that in the long nail group,and the difference was statistically significant(P<0.05).(2)In the drug experimental group,the third day after surgery: the blank blood loss of the blank control group was(601.25±105.10)ml,and the recessive blood loss of the recombinant human erythropoietin group alone was(603.30±80.18).In ml,the recessive blood loss of tranexamic acid alone was(515.70±70.33)ml,and the recessive blood loss of tranexamic acid combined with recombinant human erythropoietin was(512.80±83.27)ml.The seventh day after operation: the blank blood loss of the control group was(992.25±181.74)ml,and the recessive blood loss of the recombinant human erythropoietin group was(957.15±171.57)ml,and the tranexamic acid group was hidden.The amount of blood loss was(827.75±69.02)ml,and the amount of recessive blood loss of tranexamic acid combined with recombinant human erythropoietin was(821.50 ±105.81)ml.After statistical analysis,there was no statistically significant difference in the amount of recessive blood loss between the recombinant human-induced red group and the blank control group.There was no significant difference in the amount of recessive blood loss between the tranexamic acid alone group and the combined application group.Compared with the blank control group,the tranexamic acid group and the combined application group had significantly lower recessive blood loss than the blank control group,and the difference was statistically significant(P< 0.05).There was no significant difference in the incidence of venous thrombosis of the lower extremities in each group.ConclutionThere is more recessive blood loss after closed intramedullary fixation in elderly patients with intertrochanteric fracture.The amount of recessive blood loss is not related to gender,BMI and duration of operation.The older the patient,the diabetes,hypertension,and the main needle of intramedullary nail The longer the length,the more complex the fracture type,and the total blood loss,dominant blood loss,and recessive blood loss of the patient will increase significantly.The earlier the timing of surgery,the effective reduction of total bleeding,hidden bleeding and dominant bleeding.Tranexamic acid can effectively reduce the amount of recessive blood loss after intertrochanteric fracture in elderly patients,and its application effect is reliable and clear,and its clinical safety is high. |
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