摘要目的:探讨氨甲环酸在创伤骨折中的应用，评估氨甲环酸对股骨粗隆间骨折的患者行股骨近端防旋髓内钉(PFNA)围手术期失血量的影响，尤其是对于术后隐性失血的临床效果。方法:2016年1月至2018年12月郑州市骨科医院收治的90例股骨粗隆间骨折随机分为3组：氨甲环酸静脉滴注组(A组)，静脉滴注联合局部用药组(B组)和对照组(C组)，每组30例。氨甲环酸组手术开始前15 min按照100 ml生理盐水＋20 mg/kg快速静脉滴注，静脉滴注联合局部用药组在手术开始前15 min按照100 ml生理盐水＋20 mg/kg快速静脉滴注，切口关闭后由引流管逆行灌入2%氨甲环酸2 g＋18 ml生理盐水，对照组予以等量100 ml生理盐水滴注＋20 ml生理盐水灌入。记录术前血红蛋白和动态监测术后1、2、3 d血红蛋白及变化，术后1周、4周复查双下肢深静脉彩超，观察深静脉血栓形成(DVT)发生情况。多组间整体比较采用单因素方差分析，两两比较采用LSD- t法，计数资料采用率比较，组间比较采用 χ2，以 P<0.05为差异有统计学意义。 结果:氨甲环酸静脉滴注组围手术期总失血量、显性失血量、隐形失血量及输血量分别为(898.32±224.32)、(155.38±18.26)、(742.94±212.48)、(294.39±62.36) ml；氨甲环酸联合局部用药组围手术期总失血量、显性失血量、隐形失血量及输血量分别为(924.49±238.63)、(159.41±16.72)、(765.08±204.35)、(282.72±59.82) ml；对照组围手术期总失血量、显性失血量、隐形失血量及输血量分别为(1 221.20±249.38)、(158.82±16.34)、(1 062.38±238.74)、(404.28±71.92) ml。氨甲环酸静脉滴注组、静脉滴注联合局部用药和对照组围手术期失血量、隐性失血量比较差异有统计学意义( t＝7.276、20.880、18.580、27.350、19.720、31.280， P<0.05)；但氨甲环酸静脉滴注组、静脉滴注联合局部用药组围手术期失血量、隐性失血量比较差异无统计学意义( t＝34.180、29.820、19.820， P>0.05)，氨甲环酸静脉滴注组、静脉滴注联合局部用药组和对照组显性失血量两两比较差异无统计学意义( t＝29.140、31.300、29.130， P>0.05)。3组患者术后1周、4周经行双下肢深静脉彩超检查，均未出现双下肢深静脉血栓发生，组间差异无统计学意义( P>0.05)。 结论:氨甲环酸在减少股骨粗隆间骨折术后隐性失血方面效果显著，且不增加静脉血栓形成风险。

abstractsObjective:To explore the application of tranexamic acid in trauma fractures, and to evaluate the effect of tranexamic acid on the blood loss during perioperative period of proximal femoral intramedullary nail (PFNA) in patients with intertrochanteric fracture, Especially for the clinical effect of postoperative hidden blood loss.Methods:90 consecutive patients underwent PFNA between January 2016 and December 2018 were randomly divided into 3 groups: Tranexamic acid intravenous infusion group (group A), Tranexamic acid intravenous infusion combined with local medication group (group B), and control group (group C). In the group A, a rapid intravenous infusion of 20 mg/kg tranexamic acid was added to 100 ml of normal saline 15 minutes before the surgery.In the group B, a rapid intravenous infusion of 20 mg/kg tranexamic acid was added to 100 ml of normal saline 15 minutes before the surgery, Retrograde infusion 18ml normal saline supplemented with 2% tranexamic acid 2g through the drainage tube after the surgery.In the group C, a rapid intravenous infusion of 100ml normal saline before the surgery, Retrograde infusion 20ml normal saline through the drainage tube after the surgery.Observe and record preoperative hemoglobin and dynamic monitoring 1, 2 and 3 d hemoglobin after operation.One week and four weeks after surgery, the deep vein color Doppler ultrasound of the lower extremities was reviewed to observe the occurrence of DVT.One-way analysis of variance was used for overall comparison among multiple groups, LSD- t method was used for pairwise comparison, count data was used for rate comparison, χ2 was used for comparison between groups, and P<0.05 was considered statistically significant. Results:The total blood loss, dominant blood loss, invisible blood loss and blood transfusion in group A during the perioperative period were (898.32±224.32), (155.38±18.26), (742.94±212.48), (294.39±62.36) ml respectively; The total blood loss, dominant blood loss, invisible blood loss and blood transfusion in group B during the perioperative period were (924.49±238.63), (159.41±16.72), (765.08±204.35), (282.72±59.82) ml respectively, The total blood loss, dominant blood loss, invisible blood loss and blood transfusion in group C during the perioperative period were (1 221.20±249.38), (158.82±16.34), (1 062.38±238.74), (404.28±71.92) ml respectively.Differences in perioperative blood loss, invisible blood loss, and blood transfusion between group A and group C, group B and group C were statistically significant (Total blood loss: Group A vs. C, t=7.276; Group B vs. C, t=20.880; Invisible blood loss: Group A vs. C, t=18.580; Group B vs. Group C, t=27.350; Blood transfusion: Group A vs. Group C, t=19.720; Group B vs. Group C, t=31.280, P<0.05). There was no statistically significant difference between group A and group B during perioperative blood loss, invisible blood loss, and blood transfusion (Total blood loss: group A vs. group B, t=34.180; recessive blood loss: group A vs. group B, t=29.820; blood transfusion: group A vs. group B, t=19.820, P>0.05), There was no statistically significant difference in the dominant blood loss between group A, B and C (Dominant blood loss: group A vs. group B, t=29.140; group A vs. group C, t=31.300; blood transfusion: group B vs. group C, t=29.130, P>0.05). There were no deep vein thrombosis in both lower extremities in group A, group B and group C. The difference was not statistically significant between group A, group B and group C ( P>0.05). Conclusion:Tranexamic acid has a significant effect on reducing invisible blood loss after PFNA and does not increase the risk of venous thrombosis.