不同止血药物对老年经尿道前列腺电切患者的疗效及安全性分析  

Efficacy and safety of different hemostatic drugs in transurethral resection of the prostate in elderly patients

作　　者：刘清泉[1] 陈智[1] 周丹青[1] 张茵[1] 陈园[1] 庄乾元[1] 张存泰[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院综合医疗科,武汉430030

出　　处：《中华老年医学杂志》2016年第8期850-853,共4页Chinese Journal of Geriatrics

摘　　要：目的观察不同止血药物应用于老年经尿道前列腺电切术（TURP）患者围术期的疗效及安全性。方法选取2010年1月至2014年10月收住我院综合科和泌尿外科的老年良性前列腺增生症（BPH）患者480例，随机分为6组，每组80例。术前均口服非那雄胺1周，在TURP围术期分别应用尖吻蝮蛇血凝酶（苏灵）、白眉蛇毒血凝酶（邦亭）、矛头蝮蛇巴曲酶（立芷雪）、二乙酰氨乙酸乙二胺（迅刻）、酚磺乙胺（止血敏）联合对氨甲基苯甲酸（止血芳酸）。观察患者术中出血、围术期红细胞压积、血红蛋白的变化、膀胱持续冲洗时间、不良反应等临床指标。结果入组患者均手术顺利。应用止血药各组与对照组比较，围术期血常规变化、凝血功能、术中出血量及术后膀胱冲洗时间的差异有统计学意义（均P〈0．05）；尖吻蝮蛇血凝酶组、白眉蛇毒血凝酶组和矛头蝮蛇巴曲酶组间比较，围术期血常规变化、凝血功能、术中出血量及术后膀胱冲洗时间的差异无统计学意义（均P〉0．05）；二乙酰氨乙酸乙二胺组和酚磺乙胺联合对氨甲基苯甲酸组间比较，围术期血常规变化、凝血功能、术中出血量及术后膀胱冲洗时间的差异无统计学意义（均P〉0．05）；血凝酶组与非血凝酶组总体比较，围术期血常规变化、凝血功能、术中出血量及术后膀胱冲洗时间的差异有统计学意义（均P〈0．05）。尖吻蝮蛇血凝酶组出现纤溶反应2例，经停药和输注纤维蛋白原后好转。结论适量止血药应用于老年尤其年龄较大的TURP围术期患者临床效果好，血凝酶类止血药安全性较高，较其他类止血药有一定优势，但剂量不宜过大。Objective To investigate the efficacy and safety of perioperative use of different hemostatic drugs in elderly patients undergoing transurethral resection of the prostate （TURP）. Methods A total of 480 elderly patients with benign prostatic hyperplasia （BPH） admitted to the Departments of Urology and Gerontology of our hospital from January 2010 to October 2014 were selected and randomly divided into 6 groups （n=80, each）. Patients in all groups were given preoperative oral finasteride for 1 week, with each of the non-control groups receiving perioperative heamocoagulase agkistrodon, mangabeys hemocoagulase, reptilase, ethylenediamine diaceturate, or dicynone ＋ paraaminomethyl benzoic acid （PAMBA） . Intraoperative bleeding, perioperative hematocrit, hemoglobin change, continuous bladder irrigation time, adverse reactions and other clinical parameters were recorded. Results Operations went smoothly with all patients. Changes in perioperative blood routine indexes, coagulation function, intraoperative bleeding volume and continuous bladder irrigation time had significant differences between the control group and the groups treated with hemostatic drugs （all P〈0.05）. No significant differences in perioperative blood routine indexes, coagulation function, intraoperative bleeding volume and continuous bladder irrigation time were found between groups treated with heamocoagulase agkistrodon, mangabeys hemocoagulase and reptilase, or between groups treated with ethylenediamine diaceturate and dicynone＋ PAMBA （all P〉0.05）. There were significant differences in the perioperative blood routine indexes, coagulation function, intraoperative bleeding volume and continuous bladder irrigation time between the groupswith and without blood coagulation enzymes （all P〈0.05）. Fibrinolytic responses occurred in 2 patients in the heamocoagulase agkistrodon group and were mitigated after drug withdrawal and fibrinogen infusion. Conclusions A reasonable perioperative dose of a hemostatic drug has go

关 键 词：前列腺增生 经尿道前列腺切除术 

分 类 号：R699.8[医药卫生—泌尿科学]