探讨氨甲环酸（TXA）在减少闭合复位股骨近端防旋型髓内钉（PFNA）内固定治疗的肥胖股骨转子间骨折患者围手术期失血中的应用价值。

回顾性分析2013年11月至2018年11月因股骨转子间骨折在江门市五邑中医院接受闭合复位PFNA内固定术治疗的80例肥胖症患者的临床资料。根据围手术期是否使用TXA组将患者分为TXA和非TXA组。TXA组患者于切皮前15 min用氨甲环酸20 mg/kg缓慢静脉滴注，并在缝合皮肤前将3 g氨甲环酸稀释于50 ml生理盐水再经引流管逆行注入切口；非TXA组以等量生理盐水替代氨甲环酸。比较两组患者围手术期的凝血功能，对比两组术中出血量、总失血量和隐形失血量，对比两组输血率，术前和术后1 d、3 d的血红蛋白，记录两组的DVT和PE的发生率。

两组患者其术前的APTT、PT和D二聚体水平对比差异无统计学意义（P>0.05），术后1 d、3 d两组的APTT、PT和D二聚体水平对比差异也无统计学意义（P>0.05）；TXA组患者的总失血量、术中失血量、隐性失血量和输血率均明显低于非TXA组（P<0.05）；术后1 d、3 d的TXA组血红蛋白水平均显著高于非TXA组（P<0.05）。两组患者PE发生率和DVT形成率比较差异无统计学意义（P>0.05）。

TXA能减少闭合复位PFNA内固定治疗的肥胖股骨转子间骨折患者围手术期的失血量，且不增加深静脉血栓形成和肺栓塞的发生风险。

To explore the value of tranexamic acid (TXA) in reducing perioperative blood loss in patients with obese intertrochanteric fractures treated with closed reduction and PFNA internal fixation.

Retrospective analysis of clinical data of 80 patients with obesity who underwent closed reduction PFNA internal fixation at Wuyi Traditional Chinese Medicine Hospital of Jiangmen City from November 2013 to November 2018 due to intertrochanteric fractures. Patients were divided into TXA and non-TXA groups based on whether perioperative TXA was used. Patients in TXA group were intravenously infused with tranexamic acid 20 mg/kg 15 minutes before skin incision, and 3 g of tranexamic acid was diluted in 50 ml of normal saline before the skin was sutured and then injected retrogradely through the drainage tube into the incision. The non-TXA group replaced tranexamic acid with an equal amount of normal saline. The perioperative coagulation function, intraoperative blood loss, total blood loss and invisible blood loss, the blood transfusion rate, and the hemoglobin before and after the operation 1 and 3 days of the two groups of patients were compared. We also recorded the DVT and incidence of PE of each patient.

There was no significant difference in the APTT, PT, and D dimer levels between the two groups of patients before surgery (P>0.05). And there was no difference in the comparison of the APTT, PT, and D dimer levels between the two groups at 1 and 3 days after surgery (P>0.05); the total blood loss, blood loss during surgery, hidden blood loss, and blood transfusion rate in the TXA group were significantly lower than those in the non-TXA group (P<0.05); hemoglobin in the TXA group at 1 and 3 days after surgery was significantly higher than that in the non-TXA group (P<0.05). There was no significant difference in the incidence of PE and DVT formation between the two groups of patients (P>0.05).

TXA can reduce perioperative blood loss in obese patients with femoral intertrochanteric fractures treated with closed reduction PFNA internal fixation without increasing the risk of deep vein thrombosis and pulmonary embolism.