重组人凝血因子Ⅶa治疗急性Stanford A型主动脉夹层术后严重出血并发症的临床研究

刘鹏; 刘红阳; 黄日红; 杨光; 卞晓明; 苏德淳; 张庆华

doi:10.13201/j.issn.1001-1439.2019.02.012

重组人凝血因子Ⅶa治疗急性Stanford A型主动脉夹层术后严重出血并发症的临床研究

- 1 大连医科大学附属第一医院心脏重症监护科(辽宁大连, 116011);
- 2 大连医科大学附属第一医院心血管外科

详细信息

通讯作者: 张庆华,E-mail:off_zqh111@sina.com

中图分类号: 543543.1

收稿日期: 2018-09-27

Clinical study of recombinant activated factor Ⅶ a in the treatment of postoperative hemorrhage of type Stanford A aortic dissection

- 1 Department of Cardiology Intensive Care Unit;
- 2 Department of Cardiac Surgery, The First Affiliated Hospital of Dalian Medical University

More Information

Corresponding author: ZHANG Qinghua, E-mail: off_zqh111@sina.com

Received Date: 27 September 2018

摘要

摘要: 目的:评价重组人凝血因子Ⅶa (rFⅦa) 治疗急性Stanford A型主动脉夹层动脉瘤 (SAAAD) 外科术中不可控制的严重出血的疗效及并发症。方法:分析2016-09-2018-01于大连医科大学附属第一医院确诊的24例SAAAD患者, 在急诊外科手术停止体外循环后出现不可控制的严重出血, 将其随机分为治疗组及对照组, 对照组常规止血治疗, 治疗组给予rFⅦa 100μg/kg止血治疗, 给药前后复查弥散性血管内凝血 (DIC) 筛选。分析两组患者基础资料、术中、术后指标及预后。结果:对照组与治疗组手术时间 [(7.42±0.63) h: (6.60±0.98) h, P=0.024]有显著差异。治疗组在应用rFⅦa后, 两组活化部分凝血活酶时间 (APTT) [(53.16±6.46) s: (44.25±4.84) s, P=0.000]、纤维蛋白原 [(1.29±0.39) g/L: (1.36±0.98) g/L, P=0.043]、INR [(1.85±0.14) : (1.66±0.13), P=0.001]、术后12h输红细胞量 [(4.35±1.13) U: (3.57±1.17) U, P=0.005]、术后12h输注新鲜冰冻血浆 [(469.65±188.51) ml: (328.50±100.78) ml, P=0.000]、术后机械通气时间 [(18.78±6.99) h: (11.53±5.55) h, P=0.003]、转入ICU 24h引流量 [(657.19±100.08) ml: (519.88±107.53) ml, P=0.000]、ICU滞留时间 [(73.55±19.47) h: (89.23±23.18) h, P=0.033]均差异显著。治疗组术后输注血液制品及引流量均明显减少, 机械通气时间缩短, 但ICU滞留时间较对照组延长。结论:对于急性Stanford A型主动脉夹层外科术后不可控制的严重出血, 应用rFⅦa可缩短手术时间, 减少术后引流量、血液制品的输注及机械通气时间, 但可增加ICU滞留时间, 需密切观察不良反应发生。
- 重组人凝血因子Ⅶa /
- 急性主动脉夹层 /
- 术后出血 /
- 心脏外科手术
Abstract: Objective:To evaluate the efficacy and complications of recombinant activated factorⅦa in treatment of acute aortic dissection (Stanford A) surgery which combined with severe uncontrollable bleeding treatment.Method:We analyzed the 24 patients who diagnosed the SAAAD in the First Affiliated Hospital of Dalian Medical University from 2016.9to 2018.1.All patients had uncontrollable severe bleeding after the surgery which stopped cardiopulmonary bypass.All patients were divided into control group and treatment group at random.Patients in the treatment group were administration rFⅦa 100ug/kg.DIC screening was performed before administration and 4-6hours after administration.Result:In the two groups, the operation time was shorter in the treatment groups than control[(7.42±0.63) h vs (6.60±0.98) h, P=0.024].There were statistical differences in APTT[(53.16±6.46) s vs (44.25±4.84) s, P=0.000], Fibrinogen[(1.29±0.39) g/L vs (1.36±0.98) g/L, P=0.043], INR[(1.85±0.14) vs (1.66±0.13), P=0.001].The amount of red blood cells at 12 hours after surgery[(4.35±1.13) U vs (3.57±1.17) U, P=0.005], fresh frozen plasma at 12 hours after surgery[(469.65±188.51) ml vs (328.50±100.78) ml, P=0.000], postoperative mechanical ventilation time[(18.78±6.99) h vs (11.53±5.55) h, P=0.003], ICU 24 hours drainage[(657.19±100.08) ml vs (519.88±107.53) ml, P=0.000], ICU retention time[(73.55±19.47) h vs (89.23±23.18) h, P=0.033].Conclusion:rFⅦa can shorten the operation time, reduce postoperative drainage, reduce blood product infusion, reduce mechanical ventilation time, but increase ICU retention time after operation of SAAAD which had uncontrolled severe bleeding.
- recombinant activated factorⅦa /
- acute aortic dissection /
- postoperative hemorrhage /
- cardiac surgery

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