重组活化凝血因子Ⅶ和抑肽酶在肝移植术中的应用

Effects of recombinant factor Ⅶ (rFⅦa) and aprotinin in orthotopic liver transplantation.

目的 前瞻性地观察使用重组活化凝血因子Ⅶ（rFⅦa）和抑肽酶对减少肝移植术中出血的有效性和安全性。方法 将中山大学附属第三医院2003—2004年欲行肝移植60例病人术前随机分为3组，第1组为rFⅦa组，第2组为抑肽酶组，第3组为对照组。对3组病人各个时间点的凝血指标、凝血弹性图（TEG）指标进行观察，比较3组术中出血量、输血量、住院时间、住院费用和血管并发症。结果 使用rFⅦa后凝血酶原时间（PT）、TEG中的反应时间（R）和最大幅度（MA）与对照组差异有显著性（P〈0.05）。而部分凝血酶原时间（APTT）、纤维蛋白原水平（FIB）、血小板计数（PLT）和TEG中的血凝块减少速率（LY30）与对照组的差异无显著性（P〉0.05）。抑肽酶组与对照组MA和LY30的差异有显著性（P〈0.05），其他指标无明显改善。rFⅦa组和抑肽酶组术中出血量、输血量均较对照组明显减少（P〈0．05）。结论 rFⅦa能迅速改善外源性凝血系统功能，抑肽酶能改善新肝期的纤溶亢进，未见增加术后血管并发症。

Objective To evaluate the efficacy and safety of recombinant activated human coagulation factor Ⅶ （rFⅦa, NovoSeven） in orthotopic liver transPlantation. Methods Prospectively, sixty patients were randomized to rFVIIa treatment group aprotinin group and control group. Coagulation variables and thromboelastography （TEG） parameters [ reaction time （r）,Clot lysis at 30 minutes （LY30%）,and maximal amplitude （MA）] were recorded at described time points. Blood loss, transfusion requirements, hospital time, hospital cost and vascular complication were compared to controls. Results Administration of rFVIIa significantly shortened the prolonged prothrombin time （PT） and reaction time （r）, increase maximal amplitude （MA） significantly （ P 〈 0. 05 ）, whereas didn t influenced the activated partial thromboplastin time （APTF）,fibrinogen （FIB）,platelet count （PLT） and Clot lysis at 30 minutes （LY30%） （P 〉0. 05）. Aprotinin group only increase maximal amplitude （MA） and decrease Clot lysis at 30 minutes （ LY30% ）. In contrast with the control group, Both the perioperative blood loss and transfusion requirements were significantly reduced in rFVIIa group and aprotinin group （ P 〈0. 05）. Conclusion This study demonstrated that rFⅦa rapidly improved the exogenous coagulation function,aprotinin slowly inhibits hyperfobrinolysis, Both of them obviously reduced operation bleeding, but never increased the postoperative vascular complications. Application of rFⅦa and aprotinin are effective and safe during orthotopic liver transplantation.