氨甲环酸与尖吻蝮蛇血凝酶对老年股骨转子间骨折内固定手术止血效果比较

Comparation of Tranexamic Acid and Hemocoagulase Agkistrodon on Hemostatic Effect in Internal Fixation Surgery for Senile Femoral Trochanter Fracture

目的比较氨甲环酸与尖吻蝮蛇血凝酶对老年股骨转子间骨折内固定手术的止血效果及安全性。方法股骨转子间骨折行内固定手术治疗的老年患者100例,随机分为氨甲环酸组和尖吻蝮蛇血凝酶组(血凝酶组),各50例。氨甲环酸组切皮前30 min给予氨甲环酸1 g,静脉滴注,关闭切口前将氨甲环酸1 g稀释至20 mg·mL^(-1)于筋膜下及肌内注射。血凝酶组切皮前15 min单次缓慢静脉注射尖吻蝮蛇血凝酶2 U。观察指标:手术前后血红蛋白、红细胞计数、血小板压积,记录显性失血量、输血率、输血量、不良事件的发生情况。根据Gross线性方程计算围术期总失血量和隐性失血量。结果氨甲环酸组和血凝酶组隐性失血量分别为(215.17±148.65),(340.27±170.85)mL(P<0.01),输血量分别为(140.30±161.48),(207.20±182.59)mL(P<0.05),手术后D-二聚体分别为(4.45±4.16),(10.09±8.18)mg·L^(-1)(P<0.01)。两组显性失血量、输血率及末次随访时不良事件发生率均差异无统计学意义(均P>0.05)。结论氨甲环酸对于老年转子间骨折内固定术止血效果优于尖吻蝮蛇血凝酶,尤其可减少隐性失血量。

Objective To evaluate the safety and effect of tranexamic acid and hemocoagulase agkistrodon on hemostatic function in internal fixation for senile femoral trochanter fracture.Methods One hundred patients with femoral trochanter fractures undergoing orthopedic surgery were randomly divided into tranexamic acid and hemocoagulase agkistrodon groups,50 cases in each group.Thirty minutes before the skin incision,tranexamic acid group was intravenously dripped with 1 g of tranexamic acid and before closing the incision,1 g of tranexamic acid was diluted to 20 mg·mL^(-1) for subfascial and intramuscular injection.Hemocoagulase agkistrodon group was injected with 2 U of hemocoagulase agkistrodon,15 min before operation.Hemoglobin,red blood cell count,and platelet hematocrit before and after surgery were detected.Apparent blood loss,blood transfusion rate,blood transfusion volume,and occurrence of adverse events in each group were recorded.According to the Gross linear equation,the total blood loss and latent blood loss were calculated for the two groups during the perioperative period.Results The latent blood loss in the tranexamic acid group and hemocoagulase agkistrodon group were(215.17±148.65)mL and(340.27±170.85)mL,respectively(P<0.01).The blood transfusion volume were(140.30±161.48)mL and(207.20±182.59)mL respectively(P<0.05),postoperative D-dimer were(4.45±4.16)mg·L^(-1) and(10.09±8.18)mg·L^(-1)(P<0.01).There was no significant difference in significant blood loss,blood transfusion rate,and the incidence of adverse events at the last follow-up between the two groups(P>0.05).Conclusion Tranexamic acid is better than hemocoagulase agkistrodon in hemostatic effect on senile femoral trochanter fracture,especially for latent blood loss.