重组活化Ⅶ因子在严重多发伤凝血功能障碍中的应用

Recombinant activated factor Ⅶ for coagulopathy in patients with severe multiple injuries

目的评价重组活化Ⅶ因子（recombinantactivatedfactorⅦ，rⅦa）治疗严重多发伤失血性休克伴凝血功能障碍的效果。方法回顾性分析2011年7月-2012年6月收治的16例严重多发伤凝血功能障碍并使用rⅦa治疗的患者，比较使用rⅦa前后血制品使用量和凝血象变化情况。结果用药后9例24h内出血停止，7例出血减少并在72h内停止。生存13例，死亡3例。生存患者未见心肌梗死、脑血管意外、深静脉血栓发生。末次给药后48h较首次给药前48h输注红细胞、新鲜冰冻血浆、冷沉淀、血小板用量均减少，其中新鲜冰冻血浆及冷沉淀减少差异有统计学意义（P〈0．05）；在首次给药前及末次给药后4h内，凝血象指标凝血酶原时间、活化部分凝血活酶时间比较差异有统计学意义（P〈0．05）。结论rⅦa是严重多发伤凝血功能障碍时作为外科手术止血后的重要补充手段，效果明显、安全性高。

Objective To evaluate the effect of recombinant activated factor Ⅶ （rⅦa） in treat-ment of hemorrhagic shock after severe multiple injuries with coagulopathy. Methods Sixteen cases of coagulopathy after severe multiple injuries administered with rⅦa between July 2011 and June 2012 were reviewed. The requirements of blood product and coagulogram variation were comparatively studied before and after rⅦa therapy. Results After rⅦa therapy, bleeding was brought to a halt in 24 hours for nine cases and in 72 hours for seven cases. In the end, 13 out of the 16 cases survived in the absence of myocardial infarct, cerebrovascular accident or deep vein thrombosis. Requirements of red blood cells, fresh frozen plasma, cryoprecipitate and platelet （PLT） were decreased at 48 hours after the final therapy as compared with those at 48 hours prior to the primary therapy, but statistical significance only existed in the reduction of fresh frozen plasma and cryoprecipitate （ P 〈 0.05 ）. The coagulogram indices including prothrombin time （PT） and activated partial thromboplastin time （APTY） at 4 hours after the final therapy presented statistical differences from those prior to the primary therapy （P 〈 0.05）. Conclusion rVIIa is an important, effective and safe auxiliary means for surgical hemostasis of coagulopathy after severe multi- pie injuries.