立止血在神经外科手术麻醉的应用

Application of Reptilase in Anaesthesia of Neurosurgery

目的探讨立止血对神经外科手术的出血量、凝血功能及血小板功能的影响.方法采用前瞻、随机、双盲、对照的方法,将120例行开颅手术患者分为对照组(60例)、立止血(实验)组(60例).入室开放静脉输注勃脉力A和佳施乐,麻醉诱导插管后,开始给予立止血组2 KU立止血静脉输注.分别在给药前、30 min后和开始采血测血液中的纤维蛋白原(FIB)、PT、ACT、APTT和血小板功能指标(PLT、血小板粘附率、血小板聚集率)进行对比,并采用纱布称重法测定及记录瓶内出血量,严格计算术中失血量以及术中输血量,另外监测术后留置引流管1 d、2 d及总的引流量,对引流液中血红蛋白(Hb)含量进行分析.结果两组病人比较,立止血组的出血量、总引流量、引流液中血红蛋白含量与对照组存在显著差异,其余均无显著差异;两组病人凝血功能比较,只有两组的FIB和术前比较有差异,其余各时间点均无差异,血小板功能无差异.结论立止血在神经外科手术的麻醉过程中能有效降低术中出血量而不影响机体凝血功能和血小板功能,术后渗血明显减少,且未见任何毒副反应,是一种高效、安全、使用方便的止血药.

Objective To study the bleeding volume, platelets function and hemostatic effect of reptilase in neurosurgery operations. Methods 120 patients scheduled for craniotomy were randomly divided into 2 groups to receive either normal saline as control （n = 60） or reptilase 2 KU （n = 60）. Plasma-lyteA and Ge-lofusine were used on patients in the trial group. After induced with anaesthesia and intubated, those patients were then given reptilase through venous infusion. The blood samples were drown and coagulation parameters （FIB, PT, ACT, APTT） and platelets function parameters were tested before medication and 30 mins after that, and the results were compared. The bleeding volume in bottle were identically tested and kept in the re-cord, the bleeding volume, the volume of blood transfusion were strictly counted. The losing volume in the drain-age-tube was inspected in the first and the second day after the operations and Hb capacity was analyzed. Re-suits There was no difference in coagulation parameters between two groups except FIB, but there were signifi-cant differences 30 min after being given reptilase. There was no discrepancy in parameters except bleeding vol-ume, collective lose volume and Hb capacity. Conclusion The hemostatic effect of reptilase in anaesthesia of neurosurgery operations is very obvious.It does not affect platelets function and hemostatic effect and does not have side effect. So reptilase is a highly effective, secure and convenient drug.