骨科血友病甲患者的围手术期处理

Perioperative management of orthopaedic patients with hemophilia A

目的探讨骨科血友病甲患者行手术治疗时的围手术期处理方法。方法总结了27例骨科血友病甲患者,在围手术期通过动态监测血Ⅷ因子(FⅧ)∶C水平,调节冷沉淀FⅧ的输注剂量及间隔时间。手术前1d将患者血FⅧ∶C提高到30%～50%水平,大手术患者手术日当天提高到585%～893%,术后维持在470%～784%,小手术患者手术日当天提高到385%～525%,术后维持在292%～523%至伤口愈合。结果根据伤口愈合情况和动态测得的患者血FⅧ∶C水平随时调整输注剂量及间隔时间,使血FⅧ∶C水平维持在止血水平(30%以上),本组患者血浆冷沉淀Ⅷ因子用量为1200～70250IU,术后14～105d伤口全部愈合。结论骨科血友病甲患者手术治疗是可行的,但围手术期要求保持血中凝血因子FⅧ的促凝活性维持在止血水平,直到伤口愈合为止。

Objective To discuss the perioperative management of hemophiliacs A with orthopaedic complications Methods To regulate the injection of factor Ⅷ concentrate in perioperation by testing the level of factor Ⅷ∶C in 27 cases The lever of factor Ⅷ∶C was improved to 30%-50% at the day before the operation. To the severe patients ,it was maintained at 58 5%-89 3% during the operation and at 47 0%-78 4% in postoperation While to the gentle ,it was maintained at 38 5%-52 5% during the operation and at 29 2%-52 3% in postoperation The individualized surgical procedures were carried out, such as arthrocentesis, open knee synovectomy or arthroscopic synovectomy, evacuation or curettage of haematoma, debridements, internal fixation. Results All patients were cured in 14-105 days by regulating the injection of factor Ⅷ during the perioperation The usage of factor Ⅷ was 1 200-70 250 IU Conclusion While the hemophiliacs have orthopaedic complications ,it is necessary to promise the factor Ⅷ∶C being maintained at the lever of hemostasis during the perioperation The hemophiliacs are endurable to the operation