重组人凝血因子Ⅶa用于高危心脏手术后严重出血治疗的回顾性分析

Recombinant activated factor Ⅶa for massive blood bleeding after cardiac surgery of high risk:a report of 13 cases

目的:总结重组人凝血因子Ⅶa(rFⅦa)治疗高危心脏手术后严重出血的治疗经验。方法:对2006年10月至2007年6月13例高危心脏手术后严重出血的患者应用rFⅦa治疗后进行回顾性分析。其中男性9例,女性4例,年龄5～60岁,平均38岁。手术包括主动脉手术6例,瓣膜置换术5例,心脏移植1例,复杂先天性心脏病(先心病)1例,监测应用rFⅦa前后的治疗效果及不良反应。结果:应用rFⅦa后,心包及纵隔引流量明显减少〔(1136±348)mL对比(318±114)mL,P<0.005〕;凝血酶原时间(PT)明显缩短〔(16.8±5.9)s对比(11.3±3.3)s,P<0.05〕;国际标准化比值(INR)明显减小〔(1.3±0.4)对比(0.9±0.3),P<0.05〕;活化部分凝血活酶时间(APTT)则在用药前后差异无统计学意义〔(53.2±8.8)s对比(45.6±8.2)s,P=0.355〕。术后死亡1例(死亡原因为多器官功能衰竭),远期发生脑梗死1例。未发现心肌梗死及其他血栓性并发症。结论:对于高危心脏手术后的严重大出血的患者,及时应用rFⅦa可获得满意的治疗效果,可减少引流量,降低血液制品的输注,且不良反应发生率低。

Objective：To evaluate the therapeutic effects of administration of recombinant activated factor Ⅶa（rFⅦa） for massive blood hemorrhage after cardiac surgery of high risk.Methods：From November 2006 to June 2007,13 patients of high risk underwent cardiac surgery were administrated with with rFⅦa,male for 9 cases and female for 4 cases,aged from 5 to 60 years old with a mean of 38.The surgical procedures included aortic procedures for 6 cases,valve replacement for 5 cases,heart transplantation for 1 case,and Fontan procedure for 1 case.The efficacy and side-effects were evaluated after the use of rFⅦa.Results：After rFⅦa therapy,a significant reduction was observed in chest drain loss〔（1 136 ± 348） mL versus（318 ± 114） mL,P 0.005〕,PT〔（16.8 ± 5.9） s versus（11.3 ± 3.3） s,P 0.05〕and INR 〔（1.3 ± 0.4） versus（0.9 ± 0.3）,P 0.05〕,but there was an insignificant reduction in APTT 〔（53.2 ± 8.8） s versus（45.6 ± 8.2） s,P = 0.355〕.One patient died perioperatively of multiple system organ failure.Stroke was found in 1 patient but no myoinfarction or thrombotic complications in other patients after rFⅦa therapy.Conclusion：In-time use of rF Ⅶa can achieve good outcome for the patients underwent high-risk cardiac surgery associated with a significant reduction in blood loss,requirements for blood products and with a low incidence of side effects.