| Objective: Intertrochanteric fractures occur predominantly in the elderly with osteoporosis.Internal fixation is the preferred treatment when physical conditions permit.Due to the bleeding of the fracture itself,the intramedullary enlargement and other reasons can lead to a large amount of blood loss during the perioperative period,and severe anemia,infection,hypoperfusion,shock,and even death may occur after the operation;a large number of blood transfusions not only exacerbated the difficulty in using blood,but also caused transfusion reactions And increase family financial difficulties.Therefore,how to reduce perioperative blood loss in elderly patients with femoral intertrochanteric fractures is the key to ensuring rapid recovery after surgery and reducing the risk of death.This article analyzes the perioperative management of hemostasis and anticoagulation of elderly patients with intertrochanteric fractures under the management of accelerated rehabilitation surgery(ERAS)in combination with tranexamic acid and rivaroxaban in order to explore the combination of drugs in elderly femur Clinical value of perioperative application in patients with intertrochanteric fractures.Methods: A retrospective analysis of 60 elderly patients with intertrochanteric fractures who underwent the treatment of proximal femoral anti-rotational intramedullary nailing(PFNA)for the first time from January2018 to April 2019 in the Affiliated Hospital of Jining Medical College,2018.Patients who underwent surgery before September 11 were the control group,and patients who had undergone surgery after September 11,2018 were the test group.The test group was given an intravenous infusion of 0.5 g TXA /100 ml 5% glucose solution within 30 minutes before the incision,and within30 minutes before the skin was sutured.0.5g TXA / 100 ml 5% glucose solution was given intravenously again;the control group was given intravenous drip of the same volume of glucose solution.Collect the two groups of patients with apparent bleeding,perioperative blood loss,hidden blood loss on the first day after surgery,hidden blood loss on the third day after surgery,number of blood transfusions,blood transfusion,occurrence of thrombosis,and postoperative hospitalization.Days,etc.Results: There was no significant difference in gender,fracture side,age,height,weight,BMI,AO classification of fractures,blood index within 48 hours before surgery,length of hospital stay before surgery,and operation time between the two groups of patients(P > 0.05).Is comparable.Dominant bleeding during the operation(106.05 ± 34.34 ml VS 140.70 ±23.84ml),total perioperative blood loss(689.59 ± 247.83 VS 886.02 ±351.88),and hidden blood loss on the first day after operation(160.51 ±126.14 ml VS 457.68 ± 247.58ml),and the hidden blood loss on the third day after operation(583.54 ± 253.36 ml VS 745.32 ± 348.14ml),the test group was significantly lower than the control group,the difference wasstatistically significant(P <0.05).There was no significant difference in postoperative hospital stay(7.87 ± 3.928 days vs 11.17 ± 12.636 days)(P> 0.05).Although the postoperative hospital stay in the experimental group was not statistically significant,the average postoperative hospital stay in the experimental group was shorter than that in the control group.Three patients in the test group had blood transfusion after operation,and 7 patients in the control group had no blood transfusion after surgery.The difference was not statistically significant(P> 0.05).The total blood transfusion in the test group was 1600 ml,and the control group was 3000 ml.The number of blood transfusions in the test group and the total blood transfusion were The volume was less than that in the control group;lower extremity venous color Doppler ultrasound before discharge showed that 3 patients in each group had lower extremity intermuscular venous thrombosis,the difference was not statistically significant(P = 1.00);and no pulmonary embolism event occurred.Conclusion:Tranexamic acid(TXA)combined with rivaroxaban under the management of ERAS can reduce the total perioperative blood loss,especially the hidden blood loss,in elderly patients with femoral intertrochanteric fractures,which can reduce the total postoperative blood transfusion without increasing the risk of venous thrombosis. |
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