长期使用蛇毒血凝酶致低纤维蛋白原血症三例报告并文献复习

Hypofibrinogenemia caused by long-term administration of hemocoagulase： three cases report and literature review

目的首次报告3例长期应用蛇毒血凝酶致低纤维蛋白原血症患者。方法对3例长期应用蛇毒血凝酶致低纤维蛋白原血症患者的临床资料进行分析并复习相关文献。结果例1，女，2岁，闭合性肝脏损伤，予大量输血及输注纤维蛋白原、基因重组凝血因子VIIa、蛇毒血凝酶（2U／d）等治疗，患儿肝脏创面出血很快停止，伤后18d血浆纤维蛋白原0．12g／L；例2，男，3岁，闭合性肝脏损伤，行肝脏创口修补术，术后给予蛇毒血凝酶2U／d，术后8d腹腔引流管和静脉穿刺处大量渗血，血浆纤维蛋白原0．24g／L；例3，男，45岁，因下颌恶性肿瘤行全下颌切除术，术后给予蛇毒血凝酶4U／d，术后12d手术切口出现持续渗血，血浆纤维蛋白原0．25g／L。在停用蛇毒血凝酶并补充纤维蛋白原后，3例患者血浆纤维蛋白原与凝血检查恢复正常，例2、例3出血停止。结论蛇毒血凝酶长期应用可导致低纤维蛋白原血症与严重出血。

Objective A first report of 3 patients who developed hypofibrinogenemia due to longterm administration of hemocoagulase. Methods The clinical data of three patients with hypofibrinogenemia due to long-term administration of hemocoagulase were analyzed, and the related literature was reviewed. Results Case 1, a two-year old girl, had liver traumatic rupture and then treated with massive transfusion and fibrinogen infusion in addition to intravenous recombinant factor VII a （two times） and hemocoagulase （2 U/d）. The liver wound bleeding was soon stopped. However, her plasma fibrinogen level decreased to 0.12 g/L after continuous administration of hemocoagulase for 18 days. Case 2, a three-year old boy, had liver traumatic rupture and was treated with surgical repair, and then received hemocoagulase （2 U/d）. On the 8th day, a large amount of blood was found to exude from abdominal cavity drainage tube and indwelling venous catheter, and his fibrinogen dropped to 0.24 g/L. Case 3 was a 45 year-old man who underwent a total mandibular resection because of malignant tumor, and he was given hemocoagulase （4 U/d）. A continuous blood oozing was noted from his operation incision, and his fibrinogen level decreased to 0.25 g/L. All the three patients＇ plasma fibrinogen levels and coagulation tests returned to normal ranges after discontinuation of hemocoagulase administration and supplement of fibrinogen, and the bleeding stopped in cases 2 and 3 could induce hypofibrinogenemia and severe bleeding.