重组活化Ⅶ因子在肝移植术后急性颅内出血的应用  

Application of recombinant activated factor Ⅶ in the treatment of acute intracranial hemorrhage after liver transplantation

作　　者：许赤[1] 杨扬[1] 郭英[1] 陆敏强[1] 蔡常洁[1] 李华[1] 易述红[1] 汪根树[1] 陈规划[1] 

机构地区：[1]中山大学器官移植研究所,中山大学附属第三医院肝脏移植中心,510630

出　　处：《中华神经医学杂志》2005年第11期1122-1123,共2页Chinese Journal of Neuromedicine

基　　金：科技部973计划(2003CB515500);卫生部临床重点项目(2001321);广东省医学科研基金(A2005238)

摘　　要：目的探讨肝移植术后颅内出血病人超早期应用重组活化Ⅶ因子(rFⅦa)的疗效,及其术中应用对开颅术后颅内再出血的预防。方法回顾我院从2003年10月到2005年9月的肝移植病例,颅内出血超早期给予rFⅦa50￣60μg/kg,并在开颅术中给予rFⅦa50￣60μg/kg。结果503例肝移植中10例颅内出血,其中3例超早期应用rFⅦa结合手术治疗,2例治愈,1例因多脏器衰竭死亡;超早期应用rFⅦa结合保守治疗1例,因多脏器衰竭死亡;3例开颅术中应用rFⅦa,均未出现术后再出血,治愈。结论rFⅦa可作为肝移植术后急性颅内出血早期止血治疗的选择之一。建议采用超早期和开颅术中应用rFⅦa结合神经外科手术的治疗措施。Objective To investigate the effect of recombinant activated factor Ⅶ （rF Ⅶ a） in the treatment of acute intracranial hemorrhage after during craniotomy and postoperative rebleeding. liver transplantation, and m the prevention ot bleeding Methods The cases with intracranial hemorrhage after liver transplantation from October 2003 to September 2005 in our hospital were analyzed retrospectively, rFⅦ a 50-60 μg/kg was administered less than 4 h after intracranial hemorrhage, or 50-60 μg/kg was administered during second craniotomy for rebleeding. Results In the 503 cases undergoing liver transplantation, I0 had intracranial bleeding, among them rFⅦa was administered in 3 cases less than 4 h after intracranial hemorrhage, and combined with early neurosurgical intervention, 2 were cured, I died of multi-organ failure; 1 case was treated with ultra-early rFⅦa combined with conservative therapy, and died of multi-organ failure; 3 cases with rFⅦa administration during craniotomy had no postoperative rebleeding, and were cured. Conclusion rFVIIa may be an option for early control of acute intracranial hemorrhage after liver transplantation, Ultra-early rFⅦa administration combined with early neurosurgical intervention and rFⅦa administration during craniotomy should be considered as a therapeutic measure against acute intracranial hemorrhage after liver transplantation.

关 键 词：肝移植 颅内出血 重组活化Ⅶ因子 

分 类 号：R743[医药卫生—神经病学与精神病学] R657.3[医药卫生—临床医学]