小剂量重组活化人凝血因子Ⅶ对再次心脏多瓣膜置换术患者凝血功能的影响  

Effects of Low-dose Recombinant Activated Human Coagulation FactorⅦon Patients Undergoing Re-do Multiple Heart Valvular Surgery:a Single-center Retrospective Study

作　　者：秦学伟 陈宣伶 姚兰 佟明汇 许建屏 QIN Xuewei;CHEN Xuanling;YAO Lan;TONG Minghui;XU Jianping(Department of Anesthesiology,Peking University International Hospital,Beijing 102206,China;Department of Cardiac Surgery,Peking University International Hospital,Beijing 102206,China;Department of Cardiac Surgery,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]北京大学国际医院麻醉科,北京102206 [2]北京大学国际医院心脏外科,北京102206 [3]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院成人外科中心,北京100037

出　　处：《中国循环杂志》2023年第9期962-967,共6页Chinese Circulation Journal

基　　金：北京大学国际医院院内科研基金(YN2021QX01)。

摘　　要：目的:评估小剂量重组活化人凝血因子Ⅶ(rFⅦa)用于再次心脏多瓣膜置换术患者中对凝血功能调控的安全性及有效性。方法:回顾性收集2019年1月至2021年12月在我院行心脏多瓣膜置换术的93例患者,鱼精蛋白中和肝素后,在输注血制品及促凝血药物后,止血效果仍不理想者,麻醉医师和心脏外科医师共同决定是否给予rFⅦa,其中32例接受了rFⅦa治疗(rFⅦa组),rFⅦa剂量范围为11.23~17.54μg/kg;61例未接受rFⅦa治疗(非rFⅦa组)。收集两组患者凝血五项指标、出血量、血制品输注情况、外科重症监护室(SICU)停留时间、住院时间、术后止血探查例数、血栓性事件和死亡例数等数据。结果:手术结束(T2)时刻非rFⅦa组活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均大于rFⅦa组且超出正常范围,差异均有统计学意义(P均<0.05);T2时刻非rFⅦa组纤维蛋白原(Fib)低于rFⅦa组且低于正常范围,差异有统计学意义(P<0.05);T2时刻非rFⅦa组血小板计数(PLT)低于rFⅦa组,差异有统计学意义(P<0.05)。rFⅦa组凝血酶原时间(PT)、APTT、TT、Fib、血红蛋白(Hb)和PLT在T1至T2时刻的变化幅度均小于非rFⅦa组,差异均有统计学意义(P均<0.05);rFⅦa组术中出血量,红细胞悬液、血浆、人纤维蛋白原和人凝血酶原复合物使用量均少于非rFⅦa组,差异均有统计学意义(P均<0.05),rFⅦa组在术后2 h(T3)、术后6 h(T4)引流量均明显少于非rFⅦa组,差异均有统计学意义(P均<0.05);rFⅦa组患者在SICU停留时间和住院时间均短于非rFⅦa组,差异均有统计学意义(P均<0.05),rFⅦa组患者未出现与应用rFⅦa相关的血栓性事件。结论:本研究初步表明,小剂量rFⅦa给药可改善再次心脏多瓣膜置换术患者的凝血功能,减少术中和术后出血,而不增加血栓栓塞风险。Objectives:To evaluate the safety and efficacy of low-dose recombinant activated human coagulation factorⅦ(rFⅦa)for regulating coagulation function in patients undergoing re-do multiple heart valvular surgery.Methods:In 93 patients undergoing multiple heart valvular surgery,if the hemostasis effect was not satisfactory after protamine neutralization of heparin and infusion of blood products,anticoagulants,anesthesiologists and cardiac surgeons codetermined whether to administer rFⅦa or not,and 32 patients received rFⅦa(rFⅦa group).The dose of rFⅦa ranged from 11.23μg/kg to 17.54μg/kg.61 patients did not receive rFⅦa treatment(non-rFⅦa group).Data on coagulation index,blood loss,blood product infusion,dosage of anticoagulants,length of stay in surgical intensive care unit(SICU),length of hospital stay,number of postoperative hemostatic exploration cases,thrombotic events and mortality were compared between the two groups.Results:Compared with rFⅦa group,the values of activated partial thrombin time(APTT)and thrombin time(TT)were significantly higher and the values of fibrinogen(Fib)was significantly lower in non-rFⅦa group and lower than the normal range immediately post operation(T2)(all P<0.05).The platelet(PLT)value was significantly lower in non-rFⅦa group than in rFⅦa group(P<0.05).At T2-T1(period from the end of surgery to before infusion rFⅦa[T1]),the changes of PT,APTT,TT,Fib,Hb and PLT were significantly lower in rFⅦa group than those in non-rFⅦa group(all P<0.05).The amount of blood loss,infusion of suspended red blood cells,plasma,human fibrinogen and human prothrombin complex was significantly lower in rFⅦa group than in non-rFⅦa group(P<0.05),and the volume of drainage at T3(2 h post surgery)and T4(6 h post surgery)was significantly smaller in rFⅦa group than in non-rFⅦa group(P<0.05).The length of stay of SICU and length of hospital stay were significantly shorter in rFⅦa group than those in non-rFⅦa group(both P<0.05).There were no thrombotic events associ

关 键 词：再次心脏多瓣膜置换术 重组活化人凝血因子Ⅶ 凝血因子 凝血调控 全身麻醉 体外循环 

分 类 号：R54[医药卫生—心血管疾病]