老年股骨粗隆间骨折围手术期应用氨基己酸和氨甲环酸的临床疗效比较

doi:10.3969/j.issn.1003-9198.2024.09.015

摘要/Abstract

摘要： 目的比较氨基己酸和氨甲环酸降低老年股骨粗隆间骨折围手术期失血的临床效果。方法回顾性分析2020—2022年收治的98例行股骨粗隆间骨折闭合复位髓内钉内固定术病人的临床资料,按照围手术期使用氨基己酸或氨甲环酸分为氨基己酸组和氨甲环酸组。比较2组病人失血量及相关并发症发生情况。结果 2组病人年龄、性别、身高、体质量、BMI、术前红细胞压积、总血容量差异均无统计学意义(P＞0.05)。氨甲环酸组术后24 h内总失血量、术后24 h内隐性失血量及输血率、总输血量较氨基己酸组明显降低,差异有统计学意义(P＜0.05);2组术后24~72 h总失血量、术后24~72 h隐性失血量及术中出血量、术后引流量、术后24 h和72 h红细胞压积、住院时间、手术时间、术后静脉血栓及伤口愈合不良等并发症发生率差异均无统计学意义(P＞0.05)。结论氨甲环酸减少股骨粗隆间骨折闭合复位内固定围术期失血的效果较氨基己酸强,特别是在减少隐性失血量方面优势明显,氨甲环酸可作为老年股骨粗隆间骨折闭合复位髓内钉内固定围术期首选的抗纤溶止血药物。

关键词: 氨基己酸, 氨甲环酸, 股骨粗隆间骨折, 失血量

Abstract: Objective To compare the clinical efficacy of aminocaproic acid and tranexamic acid in reducing perioperative blood loss in the elderly patients with intertrochanteric fractures undergoing closed reduction and internal fixation with intramedullary nailing. Methods A retrospective analysis was conducted to assess the clinical data of 98 elderly patients who underwent surgery for intertrochanteric fractures from January 2020 to December 2022.The patients were divided into two groups based on intravenous administration of either aminocaproic acid (48 cases) or tranexamic acid (50 cases). Blood loss indicators and the incidence rate of complications were compared between the two groups. Results There were no significant differences in age, gender, height, weight, body mass index (BMI), preoperative hematocrit and total blood volume between the groups (P>0.05). The total blood loss volume and hidden blood loss volume within 24 hours after surgery, blood transfusion rate, total transfusion volume in the tranexamic acid group were significantly lower than those in the aminocaproic acid group (P<0.05). However, there were no significant differences in total blood loss and hidden blood loss 24-72 hours after surgery, hematocrit at 24 and 72 hours, intraoperative blood loss volume, postoperative drainage, hospital stay, operation time and the incidence rate of postoperative venous thrombosis and poor wound healing between the two groups (P>0.05). Conclusions The use of tranexamic acid during surgery in the elderly patients with intertrochanteric fractures is more effective in reducing perioperative blood loss volume, particularly hidden blood loss, compared to aminocaproic acid.Therefore, tranexamic acid is recommended as the preferred antifibrinolytic agent during surgery for intertrochanteric fractures in the elderly patients.

Key words: aminocaproic acid, tranexamic acid, intertrochanteric fracture, blood loss

中图分类号:

R681.8

李唐波, 马丙涛, 刘琳琳, 徐建强. 老年股骨粗隆间骨折围手术期应用氨基己酸和氨甲环酸的临床疗效比较[J]. 实用老年医学, 2024, 38(9): 926-930.

LI Tangbo, MA Bingtao, LIU Linlin, XU Jianqiang. Comparison of clinical efficacy of aminocaproic acid and tranexamic acid in perioperative period of elderly patients with intertrochanteric fractures[J]. Practical Geriatrics, 2024, 38(9): 926-930.

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