静脉联合局部应用氨基己酸与氨甲环酸在高龄老年股骨转子间骨折近端钉抗旋转治疗围术期的安全性分析

Efficacy and Safety of Intravenous Combination with Topical Aminohexanoic Acid and Tranexamic Acid in the Perioperative Intertrochanteric Fracture in Elderly Patients

摘要: 背景：近年来，氨甲环酸(TXA)和氨基己酸(EACA)已应用于股骨骨折闭合复位髓内针内固定术(PFNA)。然而，临床医生对于哪种药物在PFNA中更有效和安全的怀疑需要澄清。目的：探讨氨基己酸与氨甲环酸在高龄老年股骨近端钉抗旋转(PFNA)治疗老年股骨粗隆转子间骨折患者围术期应用的疗效与安全性。方法：回顾性筛选2019年1月至2022年8月于喀什地区第二人民医院行股骨骨折闭合复位髓内针内固定术的138例高龄患者，根据围术期中应用的抗纤溶止血药物不同分成2组，其中氨基己酸组73例，氨甲环酸组65例，且两组均为静脉和局部联合用药。对比两组患者在股骨骨折闭合复位髓内针内固定术期的各项失血及凝血指标、包括术后住院时间、术后并发症等情况。结果：① 术前资料：两组患者的年龄、性别、身体质量指数、患肢、OA分型、手术时间、高血压、糖尿病、心血管疾病、呼吸系统疾病、骨质疏松症以及红细胞、血小板、红细胞宽度、血红蛋白、红细胞压积、C反应蛋白、总蛋白、白蛋白、血清铁蛋白、D-二聚体、PT活动度、纤维蛋白原和纤维蛋白降解产物指标进行比较，差异均无显著性意义(P > 0.05)，而两组患者神经系统疾病(t = 14.281，P < 0.05)的差异有显著性意义；② 失血及凝血指标：氨基己酸组围术期的总失血量和隐性失血量明显少于氨甲环酸组，差异有显著性意义(P < 0.05)；氨甲环酸组和氨基己酸组的输血发生率、输血量、估算血容量和显性失血量相比差异均无显著性意义(P > 0.05)；两组患者术后第1，5天红细胞、血小板、血红蛋白、红细胞压积、C反应蛋白、总蛋白、白蛋白、血清铁蛋白、D-二聚体、PT活动度、国际化标准比(INR)、纤维蛋白原和纤维蛋白降解产物对比，差异均无显著性意义(P > 0.05)，氨基己酸组术后第1，5天红细胞宽度明显高于氨甲环酸组，差异有显著性意义(P < 0.05)；③ 两组患者住院时间、术后并发症肌间静脉血栓、深静脉血栓、肺血栓、切口感染、院内死亡、急性肾功能衰竭、癫痫、严重恶心呕吐和肺部感染的差异无统计学意义(P > 0.05)。结论：氨基己酸在高龄股骨骨折闭合复位髓内针内固定围术期中应用的止血效果比氨甲环酸更强，氨基己酸和氨甲环酸在高龄老年股骨转子间骨折围术期安全性方面基本一致；因此高龄患者在股骨骨折闭合复位髓内针内固定围术期中作者建议首选氨基己酸作为抗纤溶止血药物。

Abstract: Background: In recent years, tranexamic acid (TXA) and aminohexanoic acid (EACA) have been used in closed reduction intramedullary needle fixation (PFNA) in femoral fractures. However, clinician doubts regarding which drug is more effective and safe in PFNA require clarification. Objective: To evaluate the efficacy and safety of aminocaproic acid and tranexamic acid in antiproximal femoral nail rotation (PFNA) in elderly patients with intertrochanteric trochanteric fractures. Methods: Retroactive screening from January 2020 to April 2023 in Xinjiang medical university sixth affiliated hospital of femoral fracture closed reduction intramedullary needle fixation of 138 patients, according to the perioperative application of antifibrinolytic hemostatic drugs different divided into 2 groups, including 73 cases of aminoxigenic acid group, 65 cases of tranexamic acid group, and both groups are intravenous and topical combination. The blood loss and coagulation indexes, including the postoperative hospital stay and the postoperative complications, were compared. Results: ① preoperative data: two groups of age, sex, body mass index, affected limb, OA classification, operation time, hypertension, diabetes, cardiovascular disease, respiratory diseases, osteoporosis and red blood cells, platelets, red blood cell width, hemoglobin, hematocrit, C reactive protein, total protein, albumin, serum ferritin, D-dimer, PT activity, fibrinogen and fibrin degradation product index, No significant difference (P > 0.05), While both groups of patients with neurological disease (t = 14.281, P < 0.05); ② Blood loss and coagulation indexes: the total and recessive blood loss in the aminohexanoic acid group was significantly less than that in the tranexamic acid group, The difference was significant (P < 0.05); No difference in transfusion incidence, transfusion volume, estimated blood volume and dominant blood loss between tranexamic acid and hexanoic acid groups (P > 0.05); Two groups of patients after postoperative 1, 5 days of red blood cells, platelets, hemoglobin, hematocrit, C reactive protein, total protein, albumin, serum ferritin, D-dimer, PT activity, international standard ratio (INR), fibrinogen and fibrin degradation products, No significant difference (P > 0.05), Postoperative group 1, 5-day red cell width was significantly higher than that in the tranexamic acid group, Significant difference (P < 0.05); ③ No significant differences between the duration of hospital stay, postoperative intermuscular venous thrombosis, deep vein thrombosis, pulmonary thrombosis, incision infection, hospital death, acute renal failure, epilepsy, severe nausea and vomiting, and pulmonary infection (P > 0.05). Conclusion: Aminohexanoic acid is more effective in the perioperative period of femoral fracture, and aminohexanoic acid are basically the same. Therefore, the author recommends aminohexanoic acid as the preferred agent for femoral fracture.