重组人凝血因子Ⅶa在难治性出血治疗的临床观察
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摘要
目的:观察重组人凝血因子Ⅶa(r FⅦa)治疗难治性出血的临床现状,以增加对该止血药物的认识和理解,促进其临床应用。方法:回顾分析近5年笔者所在医院收治的难治性出血(心外科15例、胸外科10例术后出血和消化道应激性溃疡3例、创伤后凝血功能障碍7例、肝胆外科术后腹腔内出血5例)患者40例,应用r FⅦa治疗,于应用r FⅦa后3 h出血量比用药前3 h出血量、需输血量及总输血量进行对比。结果:38例患者止血成功,2例死亡。结论:使用r FⅦa治疗后38例3 h出血量比用药前3 h出血量明显减少,需输血量及总输血量明显减少。在难治性出血时,当传统方法无法有效止血时,应积极推荐应用重组人凝血因子Ⅶa治疗。
Objective:To observe the clinical present situation of recombinant human coagulation factor Ⅶa in patients with intractable blood loss,increase awareness about the hemoslatic medicine,improve the clinical application.Method:A retrospective analysis was made to investigate the effect about r FⅦ a in patients with intractable blood loss in 40 cases.There were 40 cases,15 cases after cardiac surgery,10 cases after chest surgery,5 cases of hepatobiliary,7 cases of coagulation disorders injury,3 cases of gastrointestinal stress ulcer bleeding.40 cases were treated with r FⅦ a.The amount of bleeding,the blood transfusion volume,the total volume of blood transfusion 3 hours before treated with r FⅦ a contrast 3 hours after treated with r FⅦ a.Result:38 cases were cured successfully,2 cases dead.Conclusion:38 cases treated with r FⅦ a,after 3 hours the amount of bleeding were sharp reducing,the blood transfusion volume and the total volume of blood transfusion were sharp slowdown.Patients with intractable blood loss,the conventional method unable valid stanch bleeding,ought to positive recommend treaded with r FⅦ a.
Objective:To observe the clinical present situation of recombinant human coagulation factor Ⅶa in patients with intractable blood loss,increase awareness about the hemoslatic medicine,improve the clinical application.Method:A retrospective analysis was made to investigate the effect about r FⅦ a in patients with intractable blood loss in 40 cases.There were 40 cases,15 cases after cardiac surgery,10 cases after chest surgery,5 cases of hepatobiliary,7 cases of coagulation disorders injury,3 cases of gastrointestinal stress ulcer bleeding.40 cases were treated with r FⅦ a.The amount of bleeding,the blood transfusion volume,the total volume of blood transfusion 3 hours before treated with r FⅦ a contrast 3 hours after treated with r FⅦ a.Result:38 cases were cured successfully,2 cases dead.Conclusion:38 cases treated with r FⅦ a,after 3 hours the amount of bleeding were sharp reducing,the blood transfusion volume and the total volume of blood transfusion were sharp slowdown.Patients with intractable blood loss,the conventional method unable valid stanch bleeding,ought to positive recommend treaded with r FⅦ a.
引文
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[7]Diprose P,Herbertson M J O,Shaughnessy D,et al.Activated recombinant factorⅦafter cardiopulmonary bypass reduces allogeneic transfusion in complex non-coronary cardiac surgery:randomized doubleblind placebo-controlled pilot study[J].British Journal of Anasthesia,2005,95(5):596-602.
[8]Mac Laren R,Weber L A,Brake H,et al.A multicenter assessment of recombinant factorⅦa off-label usage:clinical experiences and associated outcomes[J].Transfusion,2005,45(3):34-42.
[2]Karkouti K,Beattie W S,Wijeysundera D N,et al.Recombinant factorⅧa for intractable blood loss after cardiac surgery:a propensity scorematched case-control analysis[J].Transfusion,2005,45(2):26-34.
[3]Bowman L J.Use of Recombinant Actiyated factorⅧconcentrate to Control Postoperative Hemorrhage in Complex Cardiovascular Surgery[J].Ann Thorac Surg,2008,85(3):1669-1677.
[4]Niles S E.Increased Mortality Associated With the Early Coagulopathy of Trauma in Combat Casualties[J].J Trauma,2008,64(1):1459-1465.
[5]Romagnoli S,Bevilacqua S,Gelsomino S,et al.Small-dose recombinant activated factorⅦ(Novoseven)in cardiac surgecy[J].Anesth Analg,2006,102(5):1320-1326.
[6]Welsh A.Guidelines for the use of recombinant activated factorⅦin massive obstetric haemorrhage[J].Aust NZJ Obstet Gynaecol,2008,48(2):12-16.
[7]Diprose P,Herbertson M J O,Shaughnessy D,et al.Activated recombinant factorⅦafter cardiopulmonary bypass reduces allogeneic transfusion in complex non-coronary cardiac surgery:randomized doubleblind placebo-controlled pilot study[J].British Journal of Anasthesia,2005,95(5):596-602.
[8]Mac Laren R,Weber L A,Brake H,et al.A multicenter assessment of recombinant factorⅦa off-label usage:clinical experiences and associated outcomes[J].Transfusion,2005,45(3):34-42.