在住院时静脉注射特兰胺酸对老年外囊骨折患者输血率的影响
Zachary Reynolds1, Sarah Pirkle1, Emily Williams1
1Department of Orthopedic Surgery, Prisma Health-Upstate, Greenville, South Carolina, USA.
Advances in orthopedics
|December 31, 2025
概括
在老年人骨骨折患者中,早期的松酸 (TXA) 给药并没有显著降低输血率. 需要进一步的研究,以探索替代策略来管理流血和改善这一脆弱人群的结果.
科学领域:
- 整形外科手术 整形外科手术
- 创伤护理 创伤护理
- 老年医学 老年医学
背景情况:
- 老年人骨折经常需要输血,增加并发症风险.
- 对于骨折,建议使用特兰胺酸 (TXA),但最佳剂量和时间尚不清楚.
- 在这一群体中降低输血率是一个关键的临床目标.
研究的目的:
- 为了评估早期的松酸 (TXA) 给药在降低异性输血率方面的有效性.
- 评估TXA对外囊老年关节骨折患者输血需求的影响.
- 调查早期TXA在管理与关节骨折相关的血液损失中的作用.
主要方法:
- 从2021年到2023年,对老年脆弱性关节骨折患者 (AO/OTA 31A) 的回顾性图表审查.
- 早期接受TXA (1-g IV在呈现时和1g IV在3小时后) 的患者与没有接受TXA的患者的比较.
- 主要结局:异构输血率;次要结局:血红蛋白水平,隐性血流,停留时间和并发症.
主要成果:
- 在TXA和非TXA组之间的异构输血率没有统计学上显著的差异 (p=0.27).
- 包括血红蛋白/血红素,隐性血液损失和住院时间长度在内的二次结果在各组之间是相似的.
- 在两组中观察到可比的血栓栓塞事件率.
结论:
- 早期TXA的使用并没有显著降低老年关节骨折患者的输血率.
- 失效的潜在原因包括高并发症负担,先前存在的贫血和延迟的手术.
- 进一步的研究是有必要的,以探索替代策略的血液损失管理和优化结果在这个人群.
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