| Objective:To observe the latent blood loss after PFNA(Proximal femoral nail antirotation)in Evans Ⅲ aged patients with intertrochanteric fracture treated with intravenous tranexamic acid during preoperative anesthesia induction.Analyze its reliability and usefulness,the direction of perioperative blood loss control and rapid postoperative recovery was indicated under the guidance of intertrochanteric fracture ERAS(Enhanced recovery after surgery)concept.Methods:Sixty elderly patients with Evans Ⅲ intertrochanteric fracture who received PFNA from March 2019 to December 2019 in the Department of Orthopedics,West China Guang ’an Hospital,Sichuan University were enrolled in this experiment.Patients were equally divided into experimental group(group A)and blank control group(group B)by numerical table method.Group A received A single dose of 100mL physiological saline containing tranexamic acid 10 mg/kg intravenously during anesthesia induction.Group B was given 100mL physiological saline intravenously and slowly(all patients were given normal anticoagulant therapy after surgery according to the guidelines).The hemoglobin and hematocrit of A、B groups wererecorded1 day before surgery and 1、3 and 5 days after operation.The number of postoperative blood transfusions,thrombosis complications and blood loss in group A、B were recorded.The blood loss of groups A and B aged 65-75 years(group C)and over 75 years(group D)were recorded.After the relevant data were calculated by Nadler and Gross formula,P<0.05 was taken as the test criterion,and the relevant parameters were compared in the form of table.The whole experiment was performed according to ERAS standard of intertrochanteric fracture.Results:① Comparison of blood loss between group A and group B:The dominant blood loss(109.90±33.35)mL、the recessive blood loss(624.11±322.18)mL and the actual total blood loss(734.01±317.49)mL in group A were significantly lower than those in group B(131.47±37.56)mL、(805.19±331.68)mL、(936.66±319.83)mL,the contrast was obvious different(P<0.05);②There were 5 patients in group A(transfusion rate 16.67%)and 13 patients in group B(43.33%),and the contrast was obvious different(P<0.05).No thrombosis complication occurred in 2 groups 1 week after operation;③Contrast group A、B two groups of 65-75 years old(group C)and more than 75 years old(group D)blood loss(P<0.05);④Group A(111.53± 12.56)g/L one day before surgery、The hemoglobin value of 1 day(93.73±14.99)g/L、3 days(89.33±13.75)g/L and 5 days(93.90±11.58)g/L after surgery was higher than that of group B(108.67±13.50)g/L、(89.83±13.16)g/L、(80.57±11.37)g/L and(87.10±6.89)g/L.The hemoglobin value of the A、B groups was not different on the first day before and the first day after surgery(P>0.05).The contrast on the third and fifth day after surgery was obvious different(P<0.05).Conclusion:Its reliability and practicability in decreasing the number of blood transfusions and postoperative thrombus complications are worthy of affirmation.Its effective in the intervention of recessive blood loss after PFNA when used tranexamic acid.The intervention was effective under the guidance of ERAS concept. |
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