重组活化Ⅶ因子在普通外科手术出血并发症中的应用  

γFⅦa for the treatment of intraoperaflve bleedings in abdominal surgery

作　　者：刘建平[1] 陈涛[1] 陈积圣[1] 汪洋[1] 彭书凌[2] 李珏[2] 区庆嘉[1] 

机构地区：[1]中山大学孙逸仙纪念医院普通外科,广州510120 [2]中山大学孙逸仙纪念医院麻醉科 ,广州510120

出　　处：《中华普通外科杂志》2010年第6期484-486,共3页Chinese Journal of General Surgery

摘　　要：目的 研究观察出现手术中出血并发症后使用或者预防使用重组活化人凝血因子Ⅶ（γFVKa）的止血效果.方法 回顾分析56例外科患者（53例为肝胆外科疾病患者,3例胃肠疾病患者）使用重组活化人凝血因子Ⅶ（γfⅦa）的止血效果,分析术中使用（12例）,肝移植术前预防（30例）以及术后使用（14例）的治疗效果.结果 12例患者术中出血时使用.11例患者使用后迅速止血.其中1例肝移植患者以及1例肝癌患者术中成功止血,但术后发生肝功能衰竭死亡.另外1例肝移植患者用药后仍有继续渗血,血流动力学不稳定,无法完成手术,死亡.30例行肝移植术患者术前使用预防出血,手术均成功,患者顺利出院.14例患者术后出血使用,11例用后腹腔血性引流液减少至用药前50%以下.3例使用后,血性引流液减少不明显,血流动力学指标以及生命体征仍不稳定,死亡.总体上56例患者使用γFⅦa后,有50例患者达到救治,救治率达到89%.结论 γFⅦa可以安全地应用于多种外科手术中以及手术相关的出血并发症.Objective To investigate the efficacy of recombinant activated factor Ⅶ （γFⅦa）in the management or prevention of intraoporative bleeding in general surgery. Methods A retrospective analysis was made to investigate the effect of FⅦa in 56 surgical cases.There were 56 cases including 53 hepatobiliary cases,3 gastrointestinal surgical cflses.γFⅦa was used intraoperatively when bleeding was difficult to control in 12 patients,and in 30 liver transplant cases before a skin incision was made.γFⅦa was used in the other 14 cases postoperatively to control intraabdominal bleeding. Results Massive bleeding stopped in 11 out of 12 cases who used γFⅦa during the operation as a rescue regimen,though two of them eventually died intraoperatively for deteriorating hemedynamics,one died of intraoperative intractable bleeding in spite of the Use of γFⅦa.All the 30 liver transplant cases used γFⅦa in the prevention of intraoperative bleeding had a successful surgery.After γFⅦa was administered in 11 out of the 14 cases of postoperative bleeding,the drainage decreased by 50%.In 3 cases γFⅦa failed and hemodynamic and vital signs were still unstable.In brief,γFⅦa were safely used in bleeding control or prophylaxis.Its Successful rate reached 89% in 56 patients.No thrombus complication was found. Conclusion γFⅦ a controls perioperative hemorrhage complications.

关 键 词：因子Ⅶa 失血 手术 

分 类 号：R619.1[医药卫生—外科学]